Anest. intenziv. Med. 2026;37(2):106-110 | DOI: 10.36290/aim.2026.018

Arginine vasopressin in brain dead organ donors: pathophysiological rationale, international recommendations, and a practical approachReview Article

Píza P.¹, Kieslichová E.^{1, 2}

¹ Klinika anesteziologie, resuscitace a intenzivní péče, Transplantační centrum, Institut klinické a experimentální medicíny, Praha

² 1. lékařská fakulta Univerzity Karlovy v Praze

Brain death is associated with profound hemodynamic and endocrine disturbances that may significantly compromise the perfusion of transplantable organs. Following an initial surge of sympathetic activity, a rapid loss of sympathetic tone ensues, leading to systemic vasodilation, relative hypovolemia, and hemodynamic instability. In parallel, central diabetes insipidus frequently develops due to arginine vasopressin deficiency, manifesting as polyuria, hypernatremia, and osmotic derangements. Arginine vasopressin (AVP) is a pathophysiologically sound therapeutic option in this context, as it exerts vasoconstrictive effects via V1a receptor activation while simultaneously providing antidiuretic action through V2 receptors. AVP administration may reduce catecholamine requirements, stabilize arterial pressure, and facilitate correction of polyuria and hypernatremia. Current donor-management guidelines commonly position low-dose AVP as a preferred or early adjunctive option in catecholamine-refractory or vasoplegic hypotension and/or in concomitant central diabetes insipidus. The supporting evidence remains heterogeneous and predominantly observational. This review summarizes the rationale for AVP use in brain-dead donors, critically appraises the available data on efficacy and safety, and proposes a practical framework for initiation, titration, monitoring, and selection between AVP and desmopressin in the intensive care setting.

Keywords: organ donor, brain death, vasoplegic shock, diabetes insipidus, arginine vasopressin, noradrenaline, haemodynamic support.

Received: February 27, 2026; Revised: May 12, 2026; Accepted: May 22, 2026; Prepublished online: June 8, 2026; Published: July 10, 2026  Show citation