Aggressive pharmacologic donor management results in more transplanted organs.
BACKGROUND
Brain death results in adverse pathophysiologic effects in many cadaveric donors, resulting in cardiovascular instability and poor organ perfusion. Hormonal resuscitation (HR) has been reported to stabilize and improve cardiac function in brain-dead donors. The goal of this study was to examine the effect of HR on the brain-dead donor on the number of organs transplanted per donor.


METHODS
A retrospective analysis of all brain-dead donors recovered in the United States from January 1, 2000, to September 30, 2001, was conducted. HR consisted of a methylprednisolone bolus and infusions of vasopressin and either triiodothyronine or L-thyroxine. Univariate analyses and multivariate logistic regression analyses were used to detect differences between the HR group and those donors who did not receive HR.


RESULTS
Of 10,292 consecutive brain-dead donors analyzed, 701 received three-drug HR. Univariate analysis showed the mean number of organs from HR donors (3.8) was 22.5% greater than that from nonhormonal resuscitation donors (3.1) (P <0.001). Multivariate analyses showed that HR was associated with the following statistically significant increased probabilities of an organ being transplanted from a donor: kidney 7.3%, heart 4.7%, liver 4.9%, lung 2.8%, and pancreas 6.0%. Extrapolation of these probabilities to the 5,921 brain-dead donors recovered in 2001 was calculated to yield a total increase of 2,053 organs.


CONCLUSIONS
HR stabilizes certain brain-dead donors and is associated with significant increases in organs transplanted per donor.
Rosendale
John D
JD
Research Department, United Network for Organ Sharing, Richmond, VA 23218, USA.
Kauffman
H Myron
HM
McBride
Maureen A
MA
Chabalewski
Franki L
FL
Zaroff
Jonathan G
JG
Garrity
Edward R
ER
Delmonico
Francis L
FL
Rosengard
Bruce R
BR
D000328:Adult; D001926:Brain Death; D002648:Child; D002675:Child, Preschool; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D012076:Renal Agents / Q000627:therapeutic use; D012151:Resuscitation; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use*; D013974:Thyroxine / Q000627:therapeutic use; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*; D014284:Triiodothyronine / Q000627:therapeutic use; D014667:Vasopressins / Q000627:therapeutic use
D012076:Renal Agents; D013256:Steroids; D014284:Triiodothyronine; D014667:Vasopressins; D013974:Thyroxine