Use of Recombinant Factor VIIa to Facilitate Organ Donation in Trauma Patients with Devastating Neurologic Injury

Abstract

Organ donation serves a public health function but is also an important part of end-of-life care. Nearly 40% of organ donors are the victims of traumatic brain injury (TBI). We report on a series of patients with nonsurvivable TBI and severe coagulopathy or active hemorrhage who went on to successful organ donation with the use of recombinant factor VIIa (rFVIIa). Organ donors from a 6-year period were identified from the local Organ Procurement Organization (OPO). Medical records were reviewed, and demographics, injury-specific data, coagulation profiles, and medications administered were abstracted. Outcomes data on early graft function after transplantation were obtained. One hundred forty-eight patients had organ recovery after either brain death or withdrawal of care. Twenty-nine patients received rFVIIa and 119 patients did not. rFVIIa was administered before determination of nonsurvivability or brain death in 21 patients. In eight patients, rFVIIa was administered as a specific salvage therapy to allow donation. Mean Injury Severity Score in the rFVIIa group was 43.4 (+/-14.8) versus 34.0 (+/-13.3) in the group that did not receive rFVIIa (p = 0.001). Organs transplanted per donor were no different in the 2 groups (3.5 versus 3.6; p = 0.7). There were nearly twice as many successfully recovered lungs from the donors who received rFVIIa (44.1% versus 26.2%; p = 0.04). There was no difference in early graft function in the two groups when recipient outcomes were compared. Use of rFVIIa facilitated donation in patients with multisystem injuries who otherwise might have been ineligible for organ donation. Use of rFVIIa did not affect early graft function, although longterm outcomes are unknown. Recombinant factor VIIa is expensive, but its use is justified if the donor organ supply can be increased.