The dynamic physiologic response of human brain death and the impact of vasopressin on successful organ transplantation is reported. A 60-year-old woman was admitted to the intensive care unit after severe traumatic brain injury resulting in brain death. Initial Cushing reflex was followed by a precipitous decrease in systemic blood pressure that was refractory to the alpha-agonist phenylephrine. After intravenous vasopressin was given, hemodynamic stability was restored and maintained until successful organ transplantation. Vasopressin, a catecholamine-sparing vasopressor and antidiuretic agent, may be an effective agent in the treatment of refractory hypotension after brain death prior to organ transplantation.
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