Figure 2 .
As proposed by Novitzky, myocardial dysfunction at the time of brain death may consist of two physiologic processes.9 An initial injury is caused by a high catecholamine state (myocardial dysfunction A), and a second injury is induced by metabolic perturbations (myocardial dysfunction B). We propose that these two processes do not necessarily occur contiguously, but instead occur as a biphasic phenomenon allowing for a period of myocardial recovery. If appropriate haemodynamic support is given, the second metabolic induced injury could be delayed, allowing a window of opportunity for successful organ procurement.