title: Management of the brain-dead organ donor: a systematic review and meta-analysis.
abstract: BACKGROUND
  The shortage of organs is a limitation for transplantation, making the care of potential organ donors an important issue. The present systematic review and meta-analysis was carried out to assess the efficacy of interventions to stabilize hemodynamics in brain-dead donors or to improve organ function and outcomes of transplantation.
  
  
  METHODS
  Medline, Embase, and Cochrane databases were searched. Of 5096 articles retrieved, 39 randomized controlled trials were selected. Twenty were included in a qualitative synthesis, providing data on 1277 patients. The main interventions described were desmopressin use, triiodothyronine and methylprednisolone replacement, fluid management, vasopressor therapy, mechanical ventilation strategies, and surgical techniques.
  
  
  RESULTS
  Three meta-analyses were conducted: the first included two studies and showed that desmopressin administered to brain-dead patients was not advantageous with respect to early organ function in kidney recipients (relative risk, 0.97; 95% confidence interval [CI], 0.85-1.10; I(2) = 0%; P = 0.809). The second included four studies and showed that triiodothyronine did not add hemodynamic benefits versus standard management (weighted mean difference, 0.15; 95% CI, -0.13 to 0.42; I(2) = 17.4%; P = 0.304). The third meta-analysis (two studies) showed that ischemic liver preconditioning during harvesting procedures did not benefit survival (relative risk, 1.0; 95% CI, 0.93-1.08; I(2) = 0%; P = 0.459).
  
  
  CONCLUSIONS
  The present results suggest limited efficacy of interventions focusing on the management of brain-dead donors.
authors.affiliation: Division of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Tatiana H
authors.initials: TH
authors.lastname: Rech
authors.forename: Rafael B
authors.initials: RB
authors.lastname: Moraes
authors.forename: Daisy
authors.initials: D
authors.lastname: Crispim
authors.forename: Mauro A
authors.initials: MA
authors.lastname: Czepielewski
authors.forename: Cristiane B
authors.initials: CB
authors.lastname: Leitão
mesh_terms: D001926:Brain Death / Q000378:metabolism / Q000503:physiopathology; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage; D005440:Fluid Therapy; D006439:Hemodynamics; D020249:Hormone Replacement Therapy; D006801:Humans; D008775:Methylprednisolone / Q000008:administration & dosage; D012121:Respiration, Artificial; D014019:Tissue Donors / Q000600:supply & distribution*; D020858:Tissue and Organ Harvesting / Q000379:methods; D009927:Tissue and Organ Procurement; D019737:Transplants / Q000009:adverse effects; D014284:Triiodothyronine / Q000008:administration & dosage; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D014662:Vasoconstrictor Agents; D014284:Triiodothyronine; D003894:Deamino Arginine Vasopressin; D008775:Methylprednisolone