title: Hormone resuscitation therapy for brain-dead donors - is insulin beneficial or detrimental?
abstract: Hormonal replacement therapy to brain-dead potential organ donors remains controversial. A retrospective study was carried out of hormonal therapy on procurement of organs in 63 593 donors in whom information on thyroid hormone therapy (triiodothyronine or levothyroxine [T3 /T4 ]) was available. In 40 124 donors, T3 /T4 and all other hormonal therapy were recorded. The percentage of all organs procured, except livers, was greater when T3 /T4 had been administered. An independent beneficial effect of antidiuretic hormone (ADH) was also clear. Corticosteroids were less consistently beneficial (most frequently when T3 /T4 had not been administered), although never detrimental. Insulin was almost never beneficial and at times was associated with a reduced yield of organs, particularly of the pancreas and intestine, an observation that does not appear to have been reported previously. In addition, there was reduced survival at 12 months of recipients of pancreases from T3 /T4 -treated donors, but not of pancreas grafts. The possibly detrimental effect observed following insulin therapy is discussed.
authors.affiliation: Formerly Professor of Cardiothoracic Surgery, University of South Florida, Tampa, FL, USA.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Novitzky
authors.affiliation: Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD, USA.
authors.forename: Zhibao
authors.initials: Z
authors.lastname: Mi
authors.affiliation: Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Videla
authors.affiliation: Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD, USA.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Collins
authors.affiliation: Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: David K C
authors.initials: DK
authors.lastname: Cooper
mesh_terms: D001926:Brain Death / Q000378:metabolism*; D020249:Hormone Replacement Therapy / Q000379:methods*; D006801:Humans; D007328:Insulin / Q000494:pharmacology*; D016377:Organ Transplantation; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting; D009927:Tissue and Organ Procurement / Q000379:methods*
chemical_list: D007328:Insulin
keywords: brain death; insulin; organ donors; thyroid hormones