*Purpose: The care of a brain dead (BD) patient undergoing xenotransplantation in a non-clinical environment poses unique challenges. Selection of an appropriate decedent, stabilization of the patient in an intensive care unit (ICU) prior to the transplant using established lung and fluid management protocols for care of BD organ donors, and optimization of the non-clinical space for care during and after the xenotransplant are important. We report our experience with the peri-transplant care of the first pig-to-human xenotransplant recipients.

*Methods: Potential xenotransplant recipients were first identified by our region’s organ procurement organization, as donation after BD (DBD) patients authorized for organ donation but deemed to have no transplantable organs. Hemodynamic stability was assessed and found acceptable for both transfer to our institution and for xenotransplantation, and study consent was obtained. The patients were admitted to the Surgical ICU for optimization prior to transplant. Pre-existing DBD management protocols were utilized. The patients were then moved to a non-clinical isolation facility designated for xenotransplantation and subsequent acute care management. A temporary multi-purpose ICU/ operating room was created with both disposable and non-disposable resources dedicated for xenotransplantation. A multidisciplinary team was employed to provide critical care, including nursing, intensivists, respiratory therapy, and pharmacists.

*Results: Two DBD xenotransplant recipients were successfully optimized pre-operatively in the Surgical ICU and managed intra- and post-operatively in an isolated non-clinical setting. Bronchoscopy and donor lung recruitment was performed and standard brain death hormone replacement with steroids and levothyroxine was administered. The second recipient also initially required vasopressin for diabetes insipidus as well as vasopressor support to maintain blood pressure, both of which improved post implantation of the xenograft. Aggressive potassium and fluid repletion were required for both recipients in the setting of large volume urine output following xenotransplantation. Oxygenation was maintained despite immobility and limited pulmonary clearance.

*Conclusions: BD patients undergoing xenotransplantation can be managed in designated isolated non-clinical settings by a multidisciplinary ICU team after pre-operative optimization in a Surgical ICU using DBD management protocols.

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