Management of the brain-dead organ donor: a systematic review and meta-analysis.

Abstract

BACKGROUND:

The shortage of organs is a limitation for transplantation, making the care of potential organ donors an important issue. The present systematic review and meta-analysis was carried out to assess the efficacy of interventions to stabilize hemodynamics in brain-dead donors or to improve organ function and outcomes of transplantation.

METHODS:

Medline, Embase, and Cochrane databases were searched. Of 5096 articles retrieved, 39 randomized controlled trials were selected. Twenty were included in a qualitative synthesis, providing data on 1277 patients. The main interventions described were desmopressin use, triiodothyronine and methylprednisolone replacement, fluid management, vasopressor therapy, mechanical ventilation strategies, and surgical techniques.

RESULTS:

Three meta-analyses were conducted: the first included two studies and showed that desmopressin administered to brain-dead patients was not advantageous with respect to early organ function in kidney recipients (relative risk, 0.97; 95% confidence interval [CI], 0.85-1.10; I(2) = 0%; P = 0.809). The second included four studies and showed that triiodothyronine did not add hemodynamic benefits versus standard management (weighted mean difference, 0.15; 95% CI, -0.13 to 0.42; I(2) = 17.4%; P = 0.304). The third meta-analysis (two studies) showed that ischemic liver preconditioning during harvesting procedures did not benefit survival (relative risk, 1.0; 95% CI, 0.93-1.08; I(2) = 0%; P = 0.459).

CONCLUSION:

The present results suggest limited efficacy of interventions focusing on the management of brain-dead donors.

• Authors: Tatiana H Rech, Rafael B Moraes, Daisy Crispim, Mauro A Czepielewski, Cristiane B Leitão
• Journal: Transplantation (Transplantation) Vol. 95 Issue 7 Pg. 966-74 (Apr 15 2013) ISSN: 1534-6080 [Electronic] United States
• PMID: 23545508 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)

Chemical References

• Vasoconstrictor Agents
• Triiodothyronine
• Deamino Arginine Vasopressin
• Methylprednisolone

Topics

• Brain Death (metabolism, physiopathology)
• Deamino Arginine Vasopressin (administration & dosage)
• Fluid Therapy
• Hemodynamics
• Hormone Replacement Therapy
• Humans
• Methylprednisolone (administration & dosage)
• Respiration, Artificial
• Tissue Donors (supply & distribution)
• Tissue and Organ Harvesting (methods)
• Tissue and Organ Procurement
• Transplants (adverse effects)
• Triiodothyronine (administration & dosage)
• Vasoconstrictor Agents (administration & dosage)