*Purpose: This study attempts to identify the incidence of abdominal compartment syndrome (ACS) within the death by neurological criteria organ donor population, provide timely intervention, and determine if there is an increase in organs available for transplant. Organ donor patients may have an above-average risk for the development of ACS; measuring and identifying the instances in which this occurs leads to earlier intervention and prevention of organ injury prohibiting organ transplant. Organ procurement organizations (OPO’s) in 2019 increased lifesaving transplants to 39,718. There are still over 100,000 people in need of a lifesaving organ transplant. (UNOS 2020).

*Methods: This prospective study evaluated all death by neurological criteria organ donors in one OPO between August 2019 and March 2021. Patients were previously screened by assessing identified risk factors for developing ACS prior to bladder pressure monitoring. There was no evidence the criteria utilized for screening would capture all patients who were at risk for ACS. In this study, the OPO attempted to determine all potential risk factors for and incidence of ACS in the organ donation population. Following authorization, an initial bladder pressure was obtained. If greater than 12, bladder pressure monitoring was completed thereafter every two hours. If found to be less than twelve, pressure was obtained every 6. When patients were proned, bladder pressure was recorded 30 minutes following.

*Results: During the study period (382 patients), 66 (17%) were identified as having increased abdominal pressure (> or equal to 15), and at least one patient underwent laparotomy due to abdominal compartment syndrome and 5 patients required open abdomens. There was no significant difference in the bladder pressure due to supine versus prone positioning.

*Conclusions: For 18 months, neurologically declared organ donation patients from one OPO were monitored for intrabdominal hypertension to evaluate for increased risk in this population in whom ACS could be detrimental to organ donation. In our small sample size, there were a significant number of patients found to have abdominal hypertension. There was no significant difference in the bladder pressure due to supine versus prone positioning. Further investigation is necessary to determine impact on organ availability.

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