With the advances in surgical techniques and the emergence of potent immunosuppressive drugs, transplantation has been performed more commonly as the treatment modality for the patients with end-stage diseases of most major organs. And, because of donor organ restriction, the proper management of brain-dead donors in intensive care unit (ICU) has been recognized as a critical determinant for a successful transplantation of the harvested organ. Moreover, the favorable clinical outcomes of the recipients are directly associated with the well-preserved organ function of the brain-dead donor, which can be accomplished by the maintenance of optimal perfusion. However, brain-death causes various and profound physiologic changes such as cardiovascular, pulmonary, endocrine, or coagulation derangements. Therefore, for the maintenance of the organ from a brain-dead donor in a transplantable condition, invasive monitoring for hemodynamic stability, adequate ventilation support, and aggressive pharmacologic support including hormonal resuscitation to treat diabetes insipidus and to correct hormonal dysregulation are needed. This article reviews the pathophysiologic changes caused by brain death and the adequate management to preserve donor organs.