Levothyroxine therapy before brain death declaration increases the number of solid organ donations

Bellal Joseph, Hassan Aziz, Viraj Pandit, Narong Kulvatunyou, Moutamn Sadoun, Andrew Tang, Terence OKeeffe, Donald J. Green, Randall S. Friese, Peter Rhee

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Protocols call for the start of hormonal therapy with levothyroxine after the declaration of brain death. As the hormonal perturbations occur during the process of brain death, the role of the early initiation of levothyroxine therapy (LT) to salvage organs is not well defined. The aim of this study was to evaluate the impact of early LT (before the declaration of brain death) on the number of solid organs procured per donor. METHODS: We performed an 8-year retrospective analysis of all trauma patients who progressed to brain death. Patients who consented for organ donation, received LT, and donated solid organs were included. Patients were dichotomized into two groups: early LT group, patients who received LT before the declaration of brain death, and late LT group, those who received LT after brain death. The two groups were compared for differences in demographics, clinical characteristics, need for vasopressor, and number of solid organ donation. RESULTS: A total of 100 solid organ donors were identified of which, 41% (n=77) donors who received LT therapy were included. LT before the declaration of brain death was initiated in 37 patients compared with 40 patients who had it started after the declaration of brain death. There was no difference in demographics between the two groups except that patients in the early LT group were more likely to be hypotensive on presentation (54% vs. 25%, p = 0.001). Early LT therapy was associated with an increase in solid organ procurement rate (odds ratio, 1.9; 95% confidence interval, 1.4-2.7; p = 0.01). Sixty-seven patients donated a total of 291 solid organs. CONCLUSION: The early use of LT and aggressive blood product resuscitation was associated with a significantly higher number of solid organs donated per donor. Earlier use of LT before the declaration of brain death may be considered in potential organ donors. LEVEL OF EVIDENCE: Therapeutic/care management study, level IV.

Original languageEnglish (US)
Pages (from-to)1301-1305
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume76
Issue number5
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Tissue and Organ Procurement
Brain Death
Thyroxine
Secondary Prevention
Therapeutics
Tissue Donors
Demography
Salvage Therapy
Group Psychotherapy
Resuscitation

Keywords

  • brain death
  • Early levothyroxine therapy
  • organ donation
  • organ procurement
  • trauma

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Levothyroxine therapy before brain death declaration increases the number of solid organ donations. / Joseph, Bellal; Aziz, Hassan; Pandit, Viraj; Kulvatunyou, Narong; Sadoun, Moutamn; Tang, Andrew; OKeeffe, Terence; Green, Donald J.; Friese, Randall S.; Rhee, Peter.

In: Journal of Trauma and Acute Care Surgery, Vol. 76, No. 5, 01.01.2014, p. 1301-1305.

Research output: Contribution to journalArticle

Joseph, B, Aziz, H, Pandit, V, Kulvatunyou, N, Sadoun, M, Tang, A, OKeeffe, T, Green, DJ, Friese, RS & Rhee, P 2014, 'Levothyroxine therapy before brain death declaration increases the number of solid organ donations', Journal of Trauma and Acute Care Surgery, vol. 76, no. 5, pp. 1301-1305. https://doi.org/10.1097/TA.0000000000000184
Joseph, Bellal ; Aziz, Hassan ; Pandit, Viraj ; Kulvatunyou, Narong ; Sadoun, Moutamn ; Tang, Andrew ; OKeeffe, Terence ; Green, Donald J. ; Friese, Randall S. ; Rhee, Peter. / Levothyroxine therapy before brain death declaration increases the number of solid organ donations. In: Journal of Trauma and Acute Care Surgery. 2014 ; Vol. 76, No. 5. pp. 1301-1305.
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abstract = "BACKGROUND: Protocols call for the start of hormonal therapy with levothyroxine after the declaration of brain death. As the hormonal perturbations occur during the process of brain death, the role of the early initiation of levothyroxine therapy (LT) to salvage organs is not well defined. The aim of this study was to evaluate the impact of early LT (before the declaration of brain death) on the number of solid organs procured per donor. METHODS: We performed an 8-year retrospective analysis of all trauma patients who progressed to brain death. Patients who consented for organ donation, received LT, and donated solid organs were included. Patients were dichotomized into two groups: early LT group, patients who received LT before the declaration of brain death, and late LT group, those who received LT after brain death. The two groups were compared for differences in demographics, clinical characteristics, need for vasopressor, and number of solid organ donation. RESULTS: A total of 100 solid organ donors were identified of which, 41{\%} (n=77) donors who received LT therapy were included. LT before the declaration of brain death was initiated in 37 patients compared with 40 patients who had it started after the declaration of brain death. There was no difference in demographics between the two groups except that patients in the early LT group were more likely to be hypotensive on presentation (54{\%} vs. 25{\%}, p = 0.001). Early LT therapy was associated with an increase in solid organ procurement rate (odds ratio, 1.9; 95{\%} confidence interval, 1.4-2.7; p = 0.01). Sixty-seven patients donated a total of 291 solid organs. CONCLUSION: The early use of LT and aggressive blood product resuscitation was associated with a significantly higher number of solid organs donated per donor. Earlier use of LT before the declaration of brain death may be considered in potential organ donors. LEVEL OF EVIDENCE: Therapeutic/care management study, level IV.",
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AU - Aziz, Hassan

AU - Pandit, Viraj

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AU - Sadoun, Moutamn

AU - Tang, Andrew

AU - OKeeffe, Terence

AU - Green, Donald J.

AU - Friese, Randall S.

AU - Rhee, Peter

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