Relationship of hormonal resuscitation therapy and central venous pressure on increasing organs for transplant.
BACKGROUND
Hormonal resuscitation therapy (HRT) has been shown to increase the number of organs available for transplant. Likewise, optimal fluid balance, as measured by central venous pressure (CVP), impacts the function of donor lungs. The purpose of this study is to examine the interplay of these two variables in donor management and the impact they have on organs transplanted, with particular emphasis on hearts and lungs.


METHODS
Management of brain-dead potential organ donors was standardized in the regional OPO, including utilization of HRT in combination with a goal CVP of 4 to 8 mm Hg. Outcomes of organs transplanted per donor (OTPD) were compared between donors receiving > or =15 hours and <15 hours of L-thyroxine (T4); between donors with a final CVP <10 mm Hg vs >10 mm Hg; between donors in whom T4 was applied for > or =15 hours, and a final CVP <10 mm Hg was achieved; and those in whom one or both variables were not achieved.


RESULTS
Seventy-nine percent more hearts were transplanted from donors in whom HRT was initiated and maintained for > or =15 hours. When a final CVP <10 mm Hg was achieved, 44% more hearts, 95% more lungs and 13% more kidneys were able to be transplanted. When both variables were met, 64% more hearts, 103% more lungs, 6% more kidneys and 44% more pancreata were available for transplantation, without compromise of liver or intestinal outcomes.


CONCLUSIONS
Standardization of HRT, in combination with a CVP <10 mm Hg, significantly increases the utilization of hearts and lungs for transplantation, without negatively impacting other organ systems.
Department of Procurement, LifeSource Upper Midwest Organ Procurement Organization, St Paul, MN 55114, USA. tabdelnour@lifesource.org
Tina
T
Abdelnour
Steve
S
Rieke
D000293:Adolescent; D000328:Adult; D001926:Brain Death / Q000503:physiopathology*; D002496:Central Venous Pressure / Q000187:drug effects* / Q000502:physiology*; D002648:Child; D005260:Female; D005938:Glucocorticoids / Q000494:pharmacology*; D016027:Heart Transplantation / Q000706:statistics & numerical data; D006801:Humans; D007328:Insulin / Q000494:pharmacology*; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D016040:Lung Transplantation / Q000706:statistics & numerical data; D008297:Male; D008776:Methylprednisolone Hemisuccinate / Q000494:pharmacology*; D008875:Middle Aged; D012151:Resuscitation / Q000379:methods*; D013974:Thyroxine / Q000494:pharmacology*; D014019:Tissue Donors / Q000600:supply & distribution*; D014022:Tissue Survival / Q000187:drug effects / Q000502:physiology; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014667:Vasopressins / Q000494:pharmacology*; D014882:Water-Electrolyte Balance / Q000187:drug effects / Q000502:physiology; D055815:Young Adult
D005938:Glucocorticoids; D007328:Insulin; D014667:Vasopressins; D008776:Methylprednisolone Hemisuccinate; D013974:Thyroxine