title: Levothyroxine therapy before brain death declaration increases the number of solid organ donations.
abstract: BACKGROUND
  Protocols call for the start of hormonal therapy with levothyroxine after the declaration of brain death. As the hormonal perturbations occur during the process of brain death, the role of the early initiation of levothyroxine therapy (LT) to salvage organs is not well defined. The aim of this study was to evaluate the impact of early LT (before the declaration of brain death) on the number of solid organs procured per donor.
  
  
  METHODS
  We performed an 8-year retrospective analysis of all trauma patients who progressed to brain death. Patients who consented for organ donation, received LT, and donated solid organs were included. Patients were dichotomized into two groups: early LT group, patients who received LT before the declaration of brain death, and late LT group, those who received LT after brain death. The two groups were compared for differences in demographics, clinical characteristics, need for vasopressor, and number of solid organ donation.
  
  
  RESULTS
  A total of 100 solid organ donors were identified of which, 41% (n=77) donors who received LT therapy were included. LT before the declaration of brain death was initiated in 37 patients compared with 40 patients who had it started after the declaration of brain death. There was no difference in demographics between the two groups except that patients in the early LT group were more likely to be hypotensive on presentation (54% vs. 25%, p = 0.001). Early LT therapy was associated with an increase in solid organ procurement rate (odds ratio, 1.9; 95% confidence interval, 1.4-2.7; p = 0.01). Sixty-seven patients donated a total of 291 solid organs.
  
  
  CONCLUSIONS
  The early use of LT and aggressive blood product resuscitation was associated with a significantly higher number of solid organs donated per donor. Earlier use of LT before the declaration of brain death may be considered in potential organ donors.
  
  
  METHODS
  Therapeutic/care management study, level IV.
authors.affiliation: From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, The University of Arizona, Tucson, Arizona.
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.forename: Hassan
authors.initials: H
authors.lastname: Aziz
authors.forename: Viraj
authors.initials: V
authors.lastname: Pandit
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.forename: Moutamn
authors.initials: M
authors.lastname: Sadoun
authors.forename: Andrew
authors.initials: A
authors.lastname: Tang
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Green
authors.forename: Randall S
authors.initials: RS
authors.lastname: Friese
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001926:Brain Death; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D006085:Graft Survival; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods*; D012189:Retrospective Studies; D013974:Thyroxine / Q000008:administration & dosage*; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*; D055815:Young Adult
chemical_list: D013974:Thyroxine