Proactive complex hormone therapy in the clinical guideline for the managing the potential donor organs in brain-dead donors

Abstract

Goal of study: to improve hemodynamics, respiratory exchange and metabolism of potential donor organs by using combination of L-thyroxin, triiodothyronine, methylprednisolone, desmopressin acetate and insulin. Material and Methods: The clinical study included 98 potential donors (PD) with confirmed diagnosis of brain death. Brain-dead PD were divided into two groups: the 1st group included 43 PD with traumatic brain injury; the 2nd group included 55 PD with a stroke. PD from the 1st and 2nd groups were divided into two subgroups: main sub-group (n=18 and n=30) included those who received L-thyroxine, triiodothyronine and dessompressin orally; control sub-group (n=25 and n=25) included those who did not receive these drugs. Hemodynamics, electrolytes, biochemical parameters, respiratory exchange and free triiodothyronine and thyroxine in blood were determined during the study. Results and discussion: In the course of the intensive therapy in control subgroups of both groups of PD the doses of noradrenalin and dopamine were not changed. However, the doses of noradrenalin and dopamine were decreased significantly in main subgroups of both groups during the course of the hormone therapy. There were no significant changes in hemodynamics in PD from both control subgroups, whereas in main groups hemodynamics parameters were decreased due to hormone therapy. Significant changes of blood pressure were observed in the main subgroups. Despite exogenous administration, in the main subgroups T3 remained at the lower limit of norm, whereas T4 increased. Improved hemodynamics and gas exchange were revealed in PD following hormone therapy that was important for the blood flow in organs. Following transplantation, in recipients of organs from control subgroup of PD the rejections of the transplants were significantly more frequent than rejections of organs from PD which comprized the main subgroup receiving hormones. Conclusion. Hormone administration to brain-dead PD with confirmed brain death led to significantly reduced doses of noradrenalin and dopamine and improved hemodynamics and gas exchange parameters. Oral administration of thyroid and hypophisis hormones to PD with confirmed brain death seems feasible.