scholarly journals A multicenter randomized placebo-controlled trial of intravenous thyroxine for heart-eligible brain-dead organ donors

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Rajat Dhar ◽  
Dean Klinkenberg ◽  
Gary Marklin
Keyword(s):  
Thyroid Hormone ◽  
Organ Procurement ◽  
Hemodynamic Instability ◽  
Controlled Study ◽  
Primary Study ◽  
Organ Donors ◽  
Donor Management ◽  
Link Type ◽  
Thyroxine Treatment ◽  
Brain Dead

Abstract Background Brain death frequently induces hemodynamic instability and cardiac stunning. Impairments in cardiac performance are major contributors to hearts from otherwise eligible organ donors not being transplanted. Deficiencies in pituitary hormones (including thyroid-stimulating hormone) may contribute to hemodynamic instability, and replacement of thyroid hormone has been proposed as a means of improving stability and increasing hearts available for transplantation. Intravenous thyroxine is commonly used in donor management. However, small controlled trials have not been able to demonstrate efficacy. Methods This multicenter study will involve organ procurement organizations (OPOs) across the country. A total of 800 heart-eligible brain-dead organ donors who require vasopressor support will be randomly assigned to intravenous thyroxine for at least 12 h or saline placebo. The primary study hypotheses are that thyroxine treatment will result in a higher proportion of hearts transplanted and that these hearts will have non-inferior function to hearts not treated with thyroxine. Additional outcome measures are the time to achieve hemodynamic stability (weaning off vasopressors) and improvement in cardiac ejection fraction on echocardiography. Discussion This will be the largest randomized controlled study to evaluate the efficacy of thyroid hormone treatment in organ donor management. By collaborating across multiple OPOs, it will be able to enroll an adequate number of donors and be powered to definitively answer the critical question of whether intravenous thyroxine treatment increases hearts transplanted and/or provides hemodynamic benefits for donor management. Trial registration ClinicalTrials.govNCT04415658. Registered on June 4, 2020

Analysis of Organ Donors in the Peripartum Period

1998 ◽  
Vol 8 (1) ◽  
pp. 35-39
Author(s):  
Elizabeth C Suddaby ◽  
Margaret J Schaeffer ◽  
Lori E Brigham ◽  
Timothy R Shaver
Keyword(s):  
Organ Donor ◽  
Organ Donors ◽  
Transplant Recipients ◽  
Donor Management ◽  
Minimal Impact ◽  
Kidney Recipients ◽  
Brain Dead ◽  
Peripartum Period ◽  
Organ Donor Management ◽  
Electrolyte Abnormalities

This study was a retrospective review of 252 brain-dead potential donors from 1990 to 1996, including 5 organ donors in the peripartum period. The purpose of the study was to determine the effects of pregnancy on organ donor management and recipient outcome. Case analysis of 5 pregnant donors identified problems with hemodynamic stability and electrolyte abnormalities, including hypernatremia, hyperchloremia, and hypocalcemia. In addition, blood glucose was frequently elevated. Two donors were treated for diabetes insipidus. All 5 donors produced organs for 20 transplant recipients. Five heart recipients (including 1 heart-lung), 4 liver recipients, 4 kidney recipients, and 4 pancreas-kidney recipients have reported excellent outcomes. The use of organs from brain-dead organ donors in the peripartum period has minimal impact on donor management and recipient outcome.

A systematic review and meta-analysis of clinical trials of thyroid hormone administration to brain dead potential organ donors*

2012 ◽  
Vol 40 (5) ◽  
pp. 1635-1644 ◽  
Author(s):  
Peter S. Macdonald ◽  
Anders Aneman ◽  
Deepak Bhonagiri ◽  
Daryl Jones ◽  
Gerry O’Callaghan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Thyroid Hormone ◽  
Meta Analysis ◽  
Organ Donors ◽  
Hormone Administration ◽  
Brain Dead

How nurses shift from care of a brain-injured patient to maintenance of a brain-dead organ donor

2001 ◽  
Vol 10 (5) ◽  
pp. 306-312 ◽  
Author(s):  
L Day
Keyword(s):  
Critical Care ◽  
Organ Procurement ◽  
Injured Patient ◽  
Organ Donor ◽  
Critical Care Nurses ◽  
Organ Donors ◽  
Early Referral ◽  
Brain Injured Patient ◽  
Brain Injured ◽  
Brain Dead

BACKGROUND: The responsibility of obtaining organs for transplantation rests partly on critical care nurses. How nurses balance care of critically ill, brain-injured patients with the professional responsibility to procure organs is a question of ethical and clinical importance. OBJECTIVES: To describe the experiences of critical care nurses in making the shift from caring for a brain-injured patient identified as a potential organ donor to maintaining a brain-dead body. METHODS: An interpretive, phenomenological design was used. In 2 trauma centers, 9 critical care nurses were interviewed, and 2 of the 9 nurses were observed. RESULTS: Identification of potential organ donors is made under conditions of prognostic ambiguity. The transition from brain injury to brain death is a period of instability in which the critical care team must decide quickly whether to resuscitate a patient in order to procure organs. After a patient is brain dead, critical care nurses' relationship with and responsibility toward the patient change. CONCLUSIONS: The process of identifying potential organ donors and holding open the tentative possibility of organ procurement illustrates the practical difficulties of early referral of potential donors to organ procurement organizations. Early referral to an organ procurement organization implies a commitment to organ procurement that some nurses may hesitate to make because such a commitment changes their relationship with a brain-injured patient.

The Reward is Worth the Wait: A Prospective Analysis of 100 Consecutive Organ Donors

2012 ◽  
Vol 78 (3) ◽  
pp. 296-299 ◽  
Author(s):  
A. Britton Christmas ◽  
Tyson A. Bogart ◽  
Kristina E. Etson ◽  
Brett A. Fair ◽  
Harold R. Howe ◽  
...  
Keyword(s):  
Patient Management ◽  
Organ Procurement ◽  
Prospective Analysis ◽  
Organ Donors ◽  
Donor Management ◽  
Organ Procurement Organization ◽  
Patient Demographics ◽  
Included Patient ◽  
Initial Hypothesis

Aggressive donor management protocols have evolved to maximize the number of procured organs. Our study assessed donor management time and the number and types of organs procured with the hypothesis that shorter management time yields increased organ procurement and transplant rates. We prospectively analyzed 100 donors managed by a regional organ procurement organization (OPO) during 2007 to 2008. Data included patient demographics, number and types of organs procured and transplanted, patient management time by the OPO, and achievement of donor pre-procurement goals. One hundred consecutive organ donors were managed with a mean age 41 ± 18 years and mean management time 23 ± 9 hours; 376 organs were procured and 327 successfully transplanted. Donors managed greater than 20 hours yielded significantly more heart (5 vs 26, P < 0.01) and lung (6 vs 40, P < 0.01) procurements, more organs procured per donor (3.2 ± 1.4 vs 4.2 ± 1.6, P < 0.01), and more organs transplanted per donor (2.6 ± 1.5 vs 3.7 ± 1.8, P < 0.01) than those managed 20 hours or less. No difference in the attainment of donor management goals was observed between these populations. Contrary to our initial hypothesis, donor management times greater than 20 hours yielded increased organ procurement and transplant rates, particularly for hearts and lungs, despite no differences in the achievement of donor preprocurement management goals.

Never Declared Brain Dead Potential Organ Donors—An Additional Source of Donor Organs?

2017 ◽  
Vol 28 (1) ◽  
pp. 43-48 ◽  
Author(s):  
Patricia A. Webster ◽  
Lori E. Markham
Keyword(s):  
Outcome Measures ◽  
Organ Procurement ◽  
Retrospective Chart Review ◽  
Donation After Cardiac Death ◽  
Organ Donors ◽  
Additional Source ◽  
Imminent Death ◽  
Brain Dead ◽  
Injured Patients ◽  
Donor Organs

Context: Patients never declared brain dead may represent an additional source of donor organs. Objective: To determine the number of likely brain dead potential donors who are never declared brain dead and to compare them with brain dead and donation after cardiac death potential organ donors. Design, Setting, and Participants: This study was a retrospective chart review of all catastrophically brain-injured patients referred to a single-organ procurement organization (OPO) over a 4-year period. This study identified 159 likely brain dead potential organ donors, 902 brain dead potential organ donors, and 357 potential donation after circulatory death donors over a 4-year period. Interventions: None. Main Outcome Measures: This study did not predetermine outcome measures before data collection because the study group, likely brain dead potential organ donors, had not previously been described. Results: Likely brain dead potential donors were significantly older than brain dead potential donors ( P < .0001) but were otherwise not different demographically. They were more likely to be a late referral to the OPO ( P < .0001) and less likely to be in the donor registry ( P < .0001). The most commonly identified factors associated with a failure to declare brain death were an unwillingness to continue supportive care by the family, premention of donation, a nontimely imminent death referral, known prior objection to donation, terminal instability, and a lack of cooperation with the OPO.

Whole Blood Thiamine in Organ Donors After the Neurologic Determination of Death

2021 ◽  
pp. 152692482110246
Author(s):  
Robert S. Ream ◽  
Michelle Piole ◽  
Eric S. Armbrecht ◽  
Gary F. Marklin ◽  
Jeremy S. Garrett
Keyword(s):  
Lactic Acidosis ◽  
Whole Blood ◽  
Thiamine Deficiency ◽  
Organ Procurement ◽  
Vitamin B1 ◽  
Organ Donors ◽  
Donor Population ◽  
Hospital Stays ◽  
Brain Dead

Introduction: Metabolic resuscitation of organ donors and the attenuation of oxidative stress incurred by organs following brain death and transplantation have the potential to improve organ yield and allograft function. Thiamine (vitamin B1) is a vital coenzyme in both energy metabolism and the production of antioxidants that has not been studied in the donor population. Research Aim: To determine the frequency of subclinical thiamine deficiency in brain-dead organ donors and its correlation with demographics, length of hospitalization, donor management, lactic acidosis, and the requirement for vasoactive support. Design: Prospective cohort study of brain-dead donors managed at a single organ procurement organization’s organ recovery facility. Results: A total 64 donors were enrolled; 24 donors had thiamine levels drawn upon arrival and 40 donors had levels drawn at the time of organ procurement. Whole blood thiamine levels were inversely correlated with the time from death (P = .007) and 20% (8/40) of donors had levels below the normal range at the time of organ procurement. Demographic features of the donor were not associated with thiamine levels although longer hospital stays prior to death were associated with lower levels ( P < .05). The presence and resolution of lactic acidosis was not associated with whole blood thiamine level. Higher thiamine levels were associated with earlier discontinuation of vasoactive support ( P = .04). Discussion: Whole blood thiamine deficiency was not uncommon at the time of organ procurement. Thiamine may be associated with the requirement for hemodynamic support.

scholarly journals Effects of Terlipressin on Management of Hypotensive Brain-Dead Patients Who are Potential Organ Donors: A Retrospective Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Donghua Zheng ◽  
Genglong Liu ◽  
Li Chen ◽  
Wenfeng Xie ◽  
Jiaqi Sun ◽  
...  
Keyword(s):  
Renal Function ◽  
Retrospective Study ◽  
Liver Function ◽  
Estimated Glomerular Filtration Rate ◽  
Organ Procurement ◽  
Venous Pressure ◽  
Organ Donors ◽  
Hemodynamic Stability ◽  
Norepinephrine Dose ◽  
Brain Dead

Background: Administration of terlipressin can reverse hypotension in potential organ donors with norepinephrine-resistance. The aim of this study was to determine the effects of terlipressin on the hemodynamics, liver function, and renal function of hypotensive brain-dead patients who were potential organ donors.Methods: A retrospective study was conducted by using the ICU database of one hospital. 18 patients in a total of 294 brain-dead cases were enrolled and administered terlipressin intravenously. All physiological parameters of recruited patients were obtained at baseline, 24 and 72 h after administration, and immediately before organ procurement.Results: Terlipressin induced significant increases in mean arterial pressure (MAP) from 69.56 ± 10.68 mm Hg (baseline) to 101.82 ± 19.27 mm Hg (immediately before organ procurement) and systolic blood pressure (SBP) from 89.78 ± 8.53 mm Hg (baseline) to 133.42 ± 26.11 mm Hg (immediately before organ procurement) in all patients. The increases in MAP were accompanied by significant decreases in heart rate (HR) from 113.56 ± 28.43 bpm (baseline) to 83.89 ± 11.70 bpm (immediately before organ procurement), which resulted in the decrease of norepinephrine dose over time from 0.8 ± 0.2 μg/kg/min (baseline) to 0.09 ± 0.02 μg/kg/min (immediately before organ procurement). There were no changes in central venous pressure, liver function including aspartate aminotransferase (AST), alanine aminotransferase (ALT), and bilirubin. Renal function, assessed by serum creatinine (SCr), urine output (UOP), creatinine clearance rate (CCr), and estimated glomerular filtration rate (eGFR), improved significantly.Conclusion: Our analysis of brain-dead patients with hypotension indicates that administration of terlipressin can significantly increases MAP, SBP, UOP, CCr, and eGFR, while decreases HR and Scr. Terlipressin appears to help maintain hemodynamic stability, reduce vasoactive support, and improve renal function.

scholarly journals Intraoperative management of brain-dead organ donors by anesthesiologists during an organ procurement procedure: results from a French survey

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Benoit Champigneulle ◽  
◽  
Arthur Neuschwander ◽  
Régis Bronchard ◽  
Gersende Favé ◽  
...  
Keyword(s):  
Organ Procurement ◽  
Organ Donors ◽  
Intraoperative Management ◽  
Brain Dead ◽  
Procurement Procedure

An In-House Coordinator Program to Increase Organ Donation in Public Trauma Hospitals

1998 ◽  
Vol 8 (2) ◽  
pp. 82-87 ◽  
Author(s):  
Teresa Shafer ◽  
R. Patrick Wood ◽  
Charles Van Buren ◽  
William Guerriero ◽  
Kimberly Davis ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Organ Donation ◽  
Organ Procurement ◽  
Consent Process ◽  
Organ Donors ◽  
Consent Rate ◽  
Donor Management ◽  
Organ Procurement Organization ◽  
Conversion Rates ◽  
Organ Recovery

A 4-year retrospective study was conducted regarding the donor potential, consent rates, and organ recovery at a large 500-bed public trauma hospital. An independent organ procurement organization hired two in-house coordinators, one white and one black, to work exclusively in the hospital. The duties of the in-house coordinators included the following: working with nurses, physicians, and residents to identify donors; closely managing and coordinating the consent process; and assisting organ procurement coordinators in donor management. Following the program's implementation and the use of race-specific requesters, a 64% increase in consent rate resulted along with an overall increase of 94% in the number of organ donors. The consent rate of blacks increased 115%, whereas the number of black organ donors increased 154%. The Hispanic consent rate increased 48% with a corresponding increase of 83% in the number of Hispanic organ donors. In addition, the white consent rate increased from 55% (the 3-year average from 1993 to 1995) to 75% in 1996, resulting in a 36% increase following the implementation of the program. The investment of dedicated race-sensitive personnel in large urban county trauma facilities can result in a significant increase in donor conversion rates.

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