Significant systemic changes occur following neurologic insult and subsequent brain death. If left untreated, the hemodynamic instability and neuroendocrine alterations that ensue may significantly affect the quality of the donor organs, and contribute to posttransplant allograft dysfunction. A number of pharmacologic interventions are often implemented in an attempt to stabilize donor hemodynamics and optimize organ perfusion, thereby increasing the number and quality of cadaveric donor organs available for transplantation. This review provides a summary of these interventions, with an emphasis placed on hormonal resuscitation, which involves utilizing such agents as thyroxin, vasopressin, insulin, and corticosteroids.
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References
1.
Organ Procurement and Transplantation Network. Available at: http://www.optn.org. Accessed August 1, 2003.
2.
RazekTOlthoffKReillyM. Issues in potential organ donor management. Surg Clin N Am.2000;80:1021–1032.
3.
AvlonitisVSFisherAJKirbyJADarkJH. Pulmonary transplantation: The role of brain death in donor lung injury. Transplantation.2003;75:1928–1933.
4.
PratschkeJWilhelmMJKusakaM. Brain death and its influence on donor organ quality and outcome after transplantation. Transplantation.1999;67:343–348.
5.
HolmquistMChabalewskiFBlountTEdwardsCMcBrideVPietroskiR. A critical pathway: Guiding care for the organ donors. Crit Care Nurse. April 1999;19:84–98.
6.
PowerBMVan HeerdenPV. The physiological changes associated with brain death – current concepts and implications for treatment of the brain dead organ donor. Anaesth Intens Care.1995;23:26–36.
7.
LindopMJ. Basic principles of donor management for multiorgan removal. Transplant Proc.1991;23:2463–2464.
8.
ScheinkestelCDTuxenDVCooperDJButtW. Medical management of the (potential) organ donor. Anaesth Intens Care.1999;23:51–59.
9.
Van BakelAB. The cardiac transplant donor: Identification, assessment, and management. Am J Med Sci.1997;314:153–163.
10.
SazontsevaIEKozlovIAMoisucYGErmolenkoAEAfoninVVIlnitskiyVV. Hormonal response to brain death. Transplant Proc.1991;23:2467.
11.
PennefatherSHBullockREMantleDDarkJH. Use of low dose arginine vasopressin to support brain-dead organ donors. Transplantation.1995;59:58–62.
12.
KatzKLawlerJWaxJO'ConnorRNadkarniV. Vasopressin pressor effects in critically ill children during evaluation for brain death and organ recovery. Resuscitation.2000;47:33–40.
GuesdeRBarrouBLeblancI. Administration of desmopressin in brain-dead donors and renal function in kidney recipients. Lancet.1998;352:1178–1181.
15.
DebelakLPollakRReckardC. Arginine vasopressin versus desmopressin for the treatment of diabetes insipidus in the brain dead organ donor. Transplant Proc.1990;22:351–352.
16.
SalimAVassiliuPVelmahosGC. The role of thyroid hormone administration in potential organ donors. Arch Surg.2001;136:1377–1380.
17.
MariotJSadouneLOJacobF. Hormone levels, hemodynamics, and metabolism in brain dead organ donors. Transplant Proc.1995;27:793–794.
18.
Garcia-FagesLCCabrerCValeroRManyalichM. Hemodynamic and metabolic effects of substitutive triiodothyronine therapy in organ donors. Transplant Proc.1993;25:3038–3039.
19.
GrammHJMeinholdHBickelU. Acute endocrine failure after brain death. Transplantation.1992;54:851–857.
20.
RandellTTHockerstedtKAV. Triiodothyronine treatment is not indicated in brain-dead multiorgan donors: A controlled study. Transplant Proc.1993;25:1552–1553.
21.
NovitskyDCooperDKCReichartB. Hemodynamic and metabolic responses to hormonal therapy in brain-dead potential organ donors. Transplantation.1987;43:852–854.
22.
NovitskyDCooperDKCChaffinJSGreerAEDeBaultLEZuhdiN. Improved cardiac allograft function following triiodothyronine therapy to both donor and recipient. Transplantation.1990;49:311–316.
23.
NovitskyD. Triiodothyronine replacement, the euthyroid sick syndrome, and organ transplantation. Transplant Proc.1991;23:2460–2462.
24.
JeevanandamV. Triiodothyronine: Spectrum of use in heart transplantation. Thyroid.1997;7:139–145.
RosendaleJDKauffmanHMMcBrideMA. Aggressive pharmacologic donor management results in more transplanted organs. Transplantation.2003;75:482–487.
27.
ZaroffJGRosengardBRArmstrongWF. Consensus conference report – maximizing use of organs recovered from the cadaver donor: Cardiac recommendations. Circulation.2002;106:836–841.
28.
FolletteDMRudichSMBabcockWD. Improved oxygenation and increased lung donor recovery with high-dose steroid administration after brain death. J Heart Lung Transplant.1998;17:423–429.
29.
MassonFThicoipeMGinH. The endocrine pancreas in brain-dead donors. Transplantation.1993;56:363–367.
30.
WheeldonDRBiolMIPotterCDO. Transforming the “unacceptable” donor: Outcomes from the adoption of a standardized donor management technique. J Heart Lung Transplant.1995;14:734–742.
31.
RosendaleJDKauffmanHMMcBrideMA. Hormonal resuscitation yields more transplanted hearts, with improved early function. Transplantation.2003;75:1336–1341.
JassemWKooDDHMuiesanP. Non-heart-beating versus cadaveric and living-donor livers: Differences in inflammatory markers before transplantation. Transplantation.2003;75:1386–1390.
34.
HauptmanPJO'ConnorKJ. Medical progress: Procurement and allocation of solid organs for transplantation. N Engl J Med.1997;336:422–431.
35.
AbtPCrawfordMDesaiNMarkmannJOlthoffKShakedA. Can controlled non-heart-beating donors provide a solution to the organ shortage?Transplantation.2003;75:1627–1628.
36.
AbtPCrawfordMDesaiNMarkmannJOlthoffKShakedA. Liver transplantation from controlled non-heart-beating donors: An increased incidence of biliary complications. Transplantation.2003;75:1659–1663.
37.
FukumoriTKatoTLeviD. Use of older controlled non-heart-beating donors for liver transplantation. Transplantation.2003;75:1171–1174.
