The role of thyroid hormone administration in potential organ donors

Hypothesis: Levothyroxine sodium therapy should be used in brain-dead poten tial organ donors to reverse hemodynamic instability and to prevent cardiov ascular collapse, leading to more available organs for transplantation. Design: Prospective, before and after clinical study Setting: A surgical intensive care unit of an academic county hospital. Patients: During a 12-month period (September 1, 1999, through August 31, 2 000), we evaluated 19 hemodynamically unstable patients with traumatic and nontraumatic intracranial lesions, who were candidates for organ donation f ollowing brain death declaration. Interventions: All patients were resuscitated aggressively for organ preser vation by fluids, inotropic agents, and vasopressors. If, despite all measu res, the patients remained hemodynamically unstable, a bolus of 1 ampule of 50% dextrose, 2 g of methylprednisolone sodium succinate, 20 U of insulin, and 20 mug of levothyroxine sodium was administered, followed by a continu ous levothyroxine sodium infusion at 10 mug/h. Results: There was a significant reduction in the total vasopressor require ment after levothyroxine therapy (mean +/- SD, 11.1 +/- 0.9 mug/kg per minu te vs 6.4 +/- 1.4 mug/kg per minute, P = .02). Ten Patients (53%) had compl ete discontinuation of vasopressors. There were no failures to reach or-an donation due to cardiopulmonary arrest. Conclusions: Levothyroxine therapy plays an important role in the managemen t of hemodynamically unstable potential organ donors by decreasing vasopres sor requirements and preventing cardiovascular collapse. This may result in an increase in the quantity and quality of organs available for transplant ation.