Endocrine Considerations of the Pediatric Organ Donor

Abstract

Patients determined to be neurologically deceased exhibit potentially harmful changes in various endocrine pathways due to disruptions of the body's neurohormonal control mechanisms. These deviations from endocrine homeostasis lead to hemodynamic, metabolic, and immunologic aberrations that are associated with reduced graft procurement and function for the purposes of organ donation. Existing literature has attempted to describe the pathophysiology that associates disruptions in endocrine pathways with organ dysfunction, both to increase understanding and to identify strategies to support the donor. For example, diabetes insipidus due to arginine vasopressin deficiency is commonly encountered, and should be anticipated. The significance of abnormalities in other pathways such as those involving cortisol and thyroid hormone is less established; however, there is increasing support for treating potential organ donors with combined hormonal therapies. While there are published documents aimed at guiding management of organ donors in general, many controversies exist and pediatric-specific literature is scarce. This article aims to review several of the important endocrine-specific aspects of managing the neurologically deceased organ donor, with an emphasis on pediatrics where information is available.

Frequent Preservation of Neurologic Function in Brain Death and Brainstem Death Entails False-Positive Misdiagnosis and Cerebral Perfusion

“…Treatment of these neuroendocrine failures with an emphasis on maintaining organ functions to optimize organ donation rates is much discussed in the literature (Chamorro-Jambrina et al 2017;Gupta and Dhanani 2016;Kotloff et al 2015;Maciel and Greer 2016;Meyfroidt et al 2019;Opdam 2019). First, it is worth emphasizing that the reviews and guidance offered do not focus on preserving any brain viability that may be present, as it is assumed that there has been loss of all brain functions and viability.…”