Background <p>In contrast to intensive care, no specific recommendations regarding the anesthesiological management during organ retrieval exist in Germany. Additionally, it remains unknown how anesthesiological care is performed in the respective hospitals hosting the donor. To address this knowledge gap, this study aimed to assess current anesthesiological practice in this respect.</p> Aim <p>To document the practice of anesthesiological management in postmortem organ donation.</p> Methods <p>A&#xa0;prospective cross-sectional study was conducted among the members of the German Society for Anesthesiology and Intensive Care Medicine and the donation coordinators registered with the German Organ Procurement Organization using an anonymized online questionnaire. Besides demographic data and individual experience in managing organ donors, the actual anesthesiological approach during organ procurement was surveyed. Prior to initiation the study was registered with the German Clinical Trials Register (DRKS00033627). Statistical analysis was conducted using descriptive methods as well as multivariate logistic regression.</p> Results <p>A&#xa0;total of 951 questionnaires from respondents at hospitals with different levels of care could be analyzed (28% primary, 29% secondary, 17% tertiary, 24% university hospitals, 1% others). Responses regarding the actual approach, especially the use of different medications were heterogeneous. A&#xa0;multivariate logistic regression revealed that the hospital’s level of care and the successful completion of the organ donation coordinator curriculum might affect the administration of specific (potentially organ protective) medications, such as dopamine or glucocorticoids. Answers regarding the hemodynamic management and indications for the transfusion of blood components in organ donors were also diverse: 51% specifically indicated to aim for a&#xa0;mean arterial pressure of at least 65–69 mm Hg during the procedure, 16% stated the threshold to be below these values and another 28% aimed for higher values. In cases of hemodynamic stability 47% of the respondents would initiate the transfusion of erythrocyte concentrates at hemoglobin levels below 4.3 mmol/l (7.0 g/dl), while 50% would already administer them below 5.0 mmol/l (8.0 g/dl), when there is concomitant hemodynamic instability. Another 11% indicated that in their opinion a&#xa0;transfusion would not be indicated at all during organ procurement.</p> Conclusion <p>The anesthesiological management of postmortem organ donation in Germany currently varies significantly, which might at least in part be due to the lack of specific guidelines or recommendations. The results of the current study represent the first scientific approach regarding this issue in Germany and they underline the importance of education in this respect, especially in hospitals with lower levels of care and less frequent exposure to organ donations. The development of practice recommendations appears warranted in order to standardize the anesthesiological approach regarding organ donation, thus extending and optimizing organ-protective measures and improving outcome after solid organ transplantation.</p>