Hormone Replacement Therapy in Brain-Dead Organ Donors: A Comprehensive Review with an Emphasis on Traumatic Brain Injury

BACKGROUND Organ shortage is an ongoing problem in the United States. The vast majority of donor organs are procured following brain death and a significant portion of brain-dead donors result from devastating brain injury. Without a standard practice for hormone replacement therapy (HRT) in the setting of brain death, a comprehensive review of the literature was deemed necessary. METHODS A search of published literature was conducted with terms “TBI” or “brain injury” or “head injury” AND “hormone” or “management” AND “organ” AND “donor” or “donation.” Abstracts and full texts were screened for relevance and inclusion of information on HRT. Additional studies were selected from references cited within these. Excluded studies were non-English, non-human based, or had small sample size, (i.e., case reports or series with fewer than 5 subjects). RESULTS Fifteen studies were selected for inclusion and contained level III or IV evidence. Combinations of thyroid hormone, insulin, and corticosteroids were the most commonly cited HRT. Ninety-three percent of studies found a significant increase in organ procurement rate amongst donors who received HRT. HRT was administered after brain death declaration in eight studies. Only two studies specifically explored the effects of starting HRT earlier and identified even greater procurement rates. Four studies were specific to traumatic brain injury (TBI); the remaining eleven studies involved TBI in 22-89% of the sample. CONCLUSION Organ shortage remains a growing problem in the United States. Donor management including HRT has been proposed to combat the endocrine derangement associated with brain death and, in particular, TBI. While the existing literature reported compelling outcomes using HRT, there remains a need for further level I and II evidence studies to define optimal practice. LEVEL OF EVIDENCE IV STUDY TYPE Review article *Corresponding Author: Lauren M. Turco, MD, Trauma Research Fellow, Department of Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, Kansas 66160, Email: turco.lauren@gmail.com Conflict of Interest Statement: All authors declare no conflict of interest in either the preparation or submission of this manuscript. No funding was received from any of the following organizations: National Institutes of Health (NIH); Wellcome Trust; and the Howard Hughes Medical Institute (HHMI). © 2019 Lippincott Williams & Wilkins, Inc.

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