FIGURE 1.

Overview of metabolic changes in the liver and kidney following brain death. All changes depicted in green represent an increase in activity or level, whereas all changes marked in red denote decreased activity or levels. ⁹ All compounds marked in orange are involved in the metabolization of pyruvate into its metabolites: the pyruvate‐alanine (or Cahill) cycle involving enzyme ALT, the pyruvate‐lactate cycle involving LDH as the last step of glycolysis in the absence of oxygen, pyruvate decarboxylation involving the transformation of pyruvate to acetyl‐CoA involving PDH, and finally the formation of bicarbonate (HCO₃) from carbon dioxide (CO₂) as an end‐product of the mitochondrial TCA cycle. ALT, alanine aminotransferase; LDH, lactate dehydrogenase; PDH, pyruvate dehydrogenase; TCA, tricarboxylic acid