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 [T-3/T-4]) was available. In 40 124 donors, T-3/T-4 and all other hormonal therapy were recorded. The percentage of all organs procured, except livers, was greater when T-3/T-4 had been administered. An independent beneficial effect of antidiuretic hormone (ADH) was also clear. Corticosteroids were less consistently beneficial (most frequently when T-3/T-4 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 T-3/T-4-treated donors, but not of pancreas grafts. The possibly detrimental effect observed following insulin therapy is discussed.