ENDOCRINE STRESS REACTION TO SURGERY IN BRAIN-DEAD ORGAN DONORS

We studied the course of plasma levels of the stress markers adrenocor ticotropic hormone (ACTH), cortisol, human growth hormone (h-GH), beta -endorphin, and prolactin during retrieval surgery in eleven brain-dea d organ donors scheduled for multiple organ explantation. Donors were divided into two groups according to hemodynamic stability. Hormones d emonstrated a great variability in plasma levels and in the pattern of reaction, revealing a different degree of remaining pituitary functio n. beta-Endorphin was the only stress hormone that showed a response t o surgical stimuli in six patients. Only three of them developed a con comitant rise in ACTH. Cortisol, prolactin, and h-GH plasma levels did not change during the observation period. In the three cases with a s light elevation in ACTH, no subsequent change in cortisol was detectab le. (beta-Endorphin showed greater variability and a tendency to highe r levels in the group presenting with a higher arterial pressure, whic h resulted in a significant difference (P < 0.005) when distributions were compared using the Mann-Whitney U-test. No correlation was found between hypotensive episodes and deficiencies of other stress hormones . We conclude that pituitary function varies considerably in brain-dea d organ donors without demonstrating a correlation to the onset of hyp otension. Thus, we feel no need for a substitution treatment with any of the hormones investigated prior to organ explantation.