INTRODUCTION: Protocols call for the start of hormonal therapy with Levothyroxine after 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 purpose of this study was to evaluate the impact of early Levothyroxine therapy on organ procurement.
We performed a retrospective analysis (2004-2012) of all trauma patients who progressed to brain death, consented for organ donation, and underwent successful organ procurement. All patients received LT therapy. Patients were divided into two groups: patients who received LT prior to declaration of brain death and those who received LT after brain death. The two groups were compared for differences in demographics, clinical characteristics, need for vasopressors, and organ procurement rates.
A total of 143 patients were identified of which 47 % (n=67) received LT therapy. 67 patients donated a total of 291 solid organs. LT Therapy was started before declaration of brain death in 31 patients compared to 36 patients that had it started after declaration of brain death. The rate of organ donors was higher (4.8 vs. 3.9; p-0.05) in patients that had LT before declaration of brain death compared to those that had it started after declaration of brain death. Though patients who received LT before declaration of brain death were more likely to be hypotensive at the time of LT administration (50% vs. 17%, p-0.01); they were less likely to need vasopressor support (64% vs. 84%; p-0.06). There was no difference in the duration of the vasopressors used in either group (2292 ±2979 vs.2452±2134 mins; p-0.5).
The use of Levothyroxine therapy prior to brain death was associated with a significant higher number of solid organs donated per donor. The need for vasopressor support was less in patient who had LT started before brain death declaration. Earlier use of Levothyroxine therapy before brain death declaration should be considered.
To cite this abstract in AMA style:Joseph B, Aziz H, Pandit V, Kulvatunyou N, Tang A, Wynne J, O'Keeffe T, Friese R, Vercruysse G, Gries L, Green D, Rhee P, Gruessner R. Levothyroxine Therapy Prior to Brain Death Declaration Increases the Number of Solid Organ Donations [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/levothyroxine-therapy-prior-to-brain-death-declaration-increases-the-number-of-solid-organ-donations/. Accessed July 23, 2018.
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