title: Activation of hemostasis in brain dead organ donors: an observational study.
abstract: BACKGROUND
  Brain death is associated with a systemic inflammatory response resulting in diminished organ function in individuals transplanted with organs from brain dead donors. As inflammation is accompanied by activation of coagulation, we hypothesized that activation of hemostasis occurs in brain dead organ donors.
  
  
  OBJECTIVE
  To assess the hemostatic status in brain dead organ donors.
  
  
  METHODS
  In this study, we systematically assessed the hemostatic system in samples taken from 30 brain dead donors. As controls, blood samples from 30 living kidney donors were included.
  
  
  CONCLUSIONS
  Compared with the living donors, brain dead donors showed significant platelet activation (assessed by glycocalicin plasma levels), and a profound dysbalance in the von Willebrand factor/ADAMTS13 axis, which is key in platelet attachment to damaged vasculature. Furthermore, compared with the living donors, brain dead donors showed a significantly increased activation of secondary hemostasis with formation of fibrin (assessed by plasma levels of prothrombin fragment 1 + 2, fibrinopeptide A and D-dimer). Finally, brain dead donors showed profound hypofibrinolysis as assessed by a global clot lysis assay, which was attributed to substantially elevated plasma levels of plasminogen activator inhibitor type 1. Collectively, our results show activation of hemostasis and dysregulated fibrinolysis in brain dead organ donors. This prothrombotic state may contribute to formation of microthrombi in transplantable organs, which potentially contributes to deterioration of organ function.
authors.affiliation: Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. j.a.lisman@umcg.nl
authors.forename: T
authors.initials: T
authors.lastname: Lisman
authors.forename: H G D
authors.initials: HG
authors.lastname: Leuvenink
authors.forename: R J
authors.initials: RJ
authors.lastname: Porte
authors.forename: R J
authors.initials: RJ
authors.lastname: Ploeg
mesh_terms: D051722:ADAM Proteins / Q000378:metabolism; D000071120:ADAMTS13 Protein; D001777:Blood Coagulation; D001926:Brain Death; D005337:Fibrin / Q000096:biosynthesis; D006487:Hemostasis; D006801:Humans; D014019:Tissue Donors; D014841:von Willebrand Factor / Q000378:metabolism
chemical_list: D014841:von Willebrand Factor; D005337:Fibrin; D051722:ADAM Proteins; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human