Using thyroid hormone in brain‐dead donors to maximize the number of organs available for transplantation

Salim, Ali; Martin, Matthew J.; Brown, Carlos; Inaba, Kenji; Roth, Bradley J.; Hadjizacharia, Pantelis; Mascarenhas, Angela; Rhee, Peter; Δημητριάδης, Δημήτριος

doi:10.1111/j.1399-0012.2007.00659.x

Cited by 68 publications

(27 citation statements)

References 26 publications

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“…Additionally, fewer donors were deemed unsuitable for heart donation compared with those who received only conventional therapy (178). Recommendations for routine administration of thyroid hormone as part of donor management protocols have sparked considerable debate in the transplant community as its positive effects have not been reported in all studies (165,176,(179)(180)(181)(182)(183). The most convincing data pertain to cardiac function and heart transplantation, but conflicting reports exist even in this area (133,159,176,(183)(184)(185)(186).…”

Section: When Should Thyroid Replacement Therapy Be Considered?mentioning

confidence: 93%

“…Up to 25% of potential donors can be lost to hemodynamic instability and organ dysfunction if appropriate care is not maximized (196)(197)(198). Additionally, institution of early and aggressive HRT may improve graft function postoperatively (164,165,179,(198)(199)(200). Guidelines for the determination of brain death in children were published by a special task force in 1987 and revised recently by the SCCM, American Academy of Pediatrics, and Child Neurology Society (201)(202)(203)(204) to include six key recommendations.…”

Section: What Are the Unique Aspects Of Declaration Of Brain Death Inmentioning

confidence: 99%

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Management of the Potential Organ Donor in the ICU

Kotloff

Blosser

Fulda

et al. 2015

Critical Care Medicine

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272

150

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This document was developed through the collaborative efforts of the Society of Critical Care Medicine, the American College of Chest Physicians, and the Association of Organ Procurement Organizations. Under the auspices of these societies, a multidisciplinary, multi-institutional task force was convened, incorporating expertise in critical care medicine, organ donor management, and transplantation. Members of the task force were divided into 13 subcommittees, each focused on one of the following general or organ-specific areas: death determination using neurologic criteria, donation after circulatory death determination, authorization process, general contraindications to donation, hemodynamic management, endocrine dysfunction and hormone replacement therapy, pediatric donor management, cardiac donation, lung donation, liver donation, kidney donation, small bowel donation, and pancreas donation. Subcommittees were charged with generating a series of management-related questions related to their topic. For each question, subcommittees provided a summary of relevant literature and specific recommendations. The specific recommendations were approved by all members of the task force and then assembled into a complete document. Because the available literature was overwhelmingly comprised of observational studies and case series, representing low-quality evidence, a decision was made that the document would assume the form of a consensus statement rather than a formally graded guideline. The goal of this document is to provide critical care practitioners with essential information and practical recommendations related to management of the potential organ donor, based on the available literature and expert consensus.

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Section: When Should Thyroid Replacement Therapy Be Considered?mentioning

confidence: 93%

Section: What Are the Unique Aspects Of Declaration Of Brain Death Inmentioning

confidence: 99%

Management of the Potential Organ Donor in the ICU

Kotloff

Blosser

Fulda

et al. 2015

Critical Care Medicine

Self Cite

272

150

View full text Add to dashboard Cite

show abstract

“…As discussed previously, thyroid hormone administration remains controversial, but good outcomes with more transplantable organs have been obtained in circulatory unstable donors on high doses of vasoactive therapy. 110,111 Hemodynamic monitoring Standard ICU hemodynamic monitoring with central venous pressure (CVP) and invasive arterial pressure is generally used in all potential and actual donors. Most donors are circulatory stable with a mean arterial pressure above 70 mmHg, a CVP of 4-10 mmHg, and an adequate urine output ( 1.5 ml/kg) on dopamine infusion, 112 and do not need further invasive monitoring.…”

Section: Hemodynamic Managementmentioning

confidence: 99%

Brain death and its implications for management of the potential organ donor

Bugge

2009

Acta Anaesthesiol Scand

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The systemic physiologic changes that occur during and after brain death affect all organs suitable for transplantation. Major changes occur in the cardiovascular, pulmonary, endocrine, and immunological systems, and, if untreated may soon result in cardiovascular collapse and somatic death. Understanding these complex physiologic changes is mandatory for developing effective strategies for donor resuscitation and management in such a way that the functional integrity of potentially transplantable organs is maintained. This review elucidates these physiological changes and their consequences, and based on these consequences the rationale behind current medical management of brain-dead organ donors is discussed.

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“…In the care of organs, the goal is "to maintain body temperature, ensure adequate oxygenation, circulating blood volume, cardiovascular stability, and adequate urine output … [in order to avoid] the most common derangements, [namely] hypothermia, hypotension, and diabetes insipidus" (McKeown, Bonser, and Kellum 2012, i98-9). Some guidelines even include thyroid hormones to maximize the number of organs to be harvested (Salim et al 2007). Thus, it is not a far-fetched exaggeration to say that "once the patient goes brain dead and his relatives sign his organ donation consent form, he will get the best medical care of his life" (Teresi 2012, 146-7).…”

mentioning

confidence: 99%

Brain Death and True Patient Care

Nguyen

2016

Linacre Q

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The "brain death" standard as a criterion of death is closely associated with the need for transplantable organs from heart-beating donors. Are all of these potential donors really dead, or does the documented evidence of patients destined for organ harvesting who improve, or even recover to live normal lives, call into question the premise underlying "brain death"? The aim of this paper is to re-examine the notion of "brain death," especially its clinical test-criteria, in light of a broad framework, including medical knowledge in the field of neuro-intensive care and the traditional ethics of the medical profession. I will argue that both the empirical medical evidence and the ethics of the doctor-patient relationship point to an alternative approach toward the severely comatose patient (potential braindead donor).Lay Summary: Though legally accepted and widely practiced, the "brain death" standard for the determination of death has remained a controversial issue, especially in view of the occurrence of "chronic brain death" survivors. This paper critically re-evaluates the clinical test-criteria for "brain death," taking into account what is known about the neuro-critical care of severe brain injury. The medical evidence, together with the understanding of the moral role of the physician toward the patient present before him or her, indicate that an alternative approach should be offered to the deeply comatose patient.

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Using thyroid hormone in brain‐dead donors to maximize the number of organs available for transplantation

Cited by 68 publications

References 26 publications

Management of the Potential Organ Donor in the ICU

Management of the Potential Organ Donor in the ICU

Brain death and its implications for management of the potential organ donor

Brain Death and True Patient Care

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