The nurse is never "too prepared" when caring for the multiple organ donor. Some the many complications encountered include tachycardia, hyper/hypotension, hyper/hypothermia, diabetes insipidus, critical fluid and electrolyte imbalances, and hypoxia these are a result of brain stem herniation where the medulla herniates into the foramen magnum eventually leading to decreased cardiac output, impaired gas exchange, and impaired tissue perfusion if managed inappropriately. The challenge is on! Drug and fluid resuscitation have firm limits and guidelines which are of great importance to retrieval and transplant teams, and most of all, the recipient of the optimally perfused organ. Once the diagnosis of brain death is confirmed, the family is approached concerning their decision to donate. Psycho-emotional support of donor families is of upmost importance and you, the nurse, may call upon clergy, hospice, social services, or the transplant coordinator to assist. The organ procurement process involves the nurse, the transplant coordinator, and the physician. Since it is the nurse who will be "standing vigil" at the client's bedside, the very important role of anticipating the potential problems is crucial and this cannot be achieved unless we have a sound knowledge in the pathophysiology of central herniation.