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The primary cause of hypotension immediately following brain death is massive vasodilation. When brain death occurs, there is a loss of autonomic regulation of the cardiovascular system due to the loss of brain function, particularly in areas that control vascular tone. This results in significant dilation of blood vessels, leading to a decrease in systemic vascular resistance. Consequently, the heart is unable to maintain adequate blood pressure despite normal or increased cardiac output.

In a normal physiological state, the autonomic nervous system helps regulate blood vessel constriction and dilation, maintaining blood pressure. However, after brain death, the overwhelming systemic vasodilation creates a state where the body's blood pressure drops significantly, often referred to as neurogenic shock. This mechanism is crucial to understand in the context of transplant nursing, as managing blood pressure and perfusion becomes critical in the care of brain-dead donors prior to organ procurement.

Other causes such as hemorrhage, fluid overload, and sepsis can also contribute to hypotension, but they are not the primary mechanisms at play immediately after brain death. Hemorrhage results in loss of blood volume, fluid overload can lead to different hemodynamic issues, and sepsis is associated with infection and inflammation rather than the immediate effects following brain death. Understanding the