Optimizing Donor Quality Via Hormonal Therapy: An Important Strategy to Increase Successful Placement of Thoracic Organs in End-Stage Patients

Abstract

See related article on pages 123–132. Although human organ transplantation continues to be the only definitive treatment of end-stage organ dysfunction, scarcity of donor organs remains an overwhelming limiting factor. According to the Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) data, in the year 2014, 379 patients died while awaiting heart transplantation and 218 patients died waiting for lung transplantation. Nationally, the donor heart usage rate is approximately 30% and lung usage rate is approximately 25%. Optimizing resuscitation of organ donors is an important approach suggested to maximize procurement of thoracic organs. Reports dating back to the 1980s have documented decreased organ viability in brain-dead donors, due to metabolic derangement and hemodynamic instability. To combat the sequelae of brain death, the use of hormonal resuscitation therapy has been suggested. Although increasingly many centers are incorporating thyroid hormone (T3/T4) therapy in the management of hemodynamically unstable donors, its routine use has been controversial owing to conflicting data regarding its efficacy and some evidence that such therapy increases the risk of allograft rejection. In their retrospective study, Novitzky et al use the UNOS database to analyze the effect of thyroid hormone replacement therapy in the management of 63,593 brain-dead potential organ donors. Administration of thyroid hormone therapy was noted to significantly increase the number of thoracic organs procured. T3/T4 therapy increased heart procurement by approximately 9% and lung procurement by 6%. Thyroid hormone therapy was found to either increase recipient survival or have no beneficial or detrimental effect on survival at 1 month or 12 months after transplantation. The authors conclude that T3/T4 therapy should be considered in all brain-dead potential donors as it significantly increases the organ procurement rate with improved or comparable posttransplant survival. The study cohort is large and the analysis by the authors is nuanced. The findings must be considered in the light of