Download PDF
J Pediatr Intensive Care 2016; 05(04): 205-212
DOI: 10.1055/s-0036-1583286
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Endocrine Considerations of the Pediatric Organ Donor

Ronish Gupta
1   Division of Critical Care, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
,
Sonny Dhanani
1   Division of Critical Care, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
› Author Affiliations
Further Information

Publication History

27 September 2015

25 November 2015

Publication Date:
17 May 2016 (online)

    Permissions and Reprints

Abstract

Patients determined to be neurologically deceased exhibit potentially harmful changes in various endocrine pathways due to disruptions of the body's neurohormonal control mechanisms. These deviations from endocrine homeostasis lead to hemodynamic, metabolic, and immunologic aberrations that are associated with reduced graft procurement and function for the purposes of organ donation. Existing literature has attempted to describe the pathophysiology that associates disruptions in endocrine pathways with organ dysfunction, both to increase understanding and to identify strategies to support the donor. For example, diabetes insipidus due to arginine vasopressin deficiency is commonly encountered, and should be anticipated. The significance of abnormalities in other pathways such as those involving cortisol and thyroid hormone is less established; however, there is increasing support for treating potential organ donors with combined hormonal therapies. While there are published documents aimed at guiding management of organ donors in general, many controversies exist and pediatric-specific literature is scarce. This article aims to review several of the important endocrine-specific aspects of managing the neurologically deceased organ donor, with an emphasis on pediatrics where information is available.

Keywords

brain death - organ procurement - endocrine system diseases - hormone - donation - organ donor management
 

  • References

  • 1 Services USD of H and H. Organ Procurement and Transplantation Network. Available at: http://optn.transplant.hrsa.gov/ . Accessed August 24, 2015
    PubMedGoogle Scholar
  • 2 Inaba K, Branco BC, Lam L , et al. Organ donation and time to procurement: late is not too late. J Trauma 2010; 68 (6) 1362-1366
    CrossrefPubMedGoogle Scholar
  • 3 Tsai E, Shemie SD, Cox PN, Furst S, McCarthy L, Hebert D. Organ donation in children: role of the pediatric intensive care unit. Pediatr Crit Care Med 2000; 1 (2) 156-160
    CrossrefPubMedGoogle Scholar
  • 4 Malinoski DJ, Patel MS, Daly MC, Oley-Graybill C, Salim A ; UNOS Region 5 DMG workgroup. The impact of meeting donor management goals on the number of organs transplanted per donor: results from the United Network for Organ Sharing Region 5 prospective donor management goals study. Crit Care Med 2012; 40 (10) 2773-2780
    CrossrefPubMedGoogle Scholar
  • 5 Kotloff RM, Blosser S, Fulda GJ , et al; Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations Donor Management Task Force. Management of the potential organ donor in the ICU: Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations Consensus Statement. Crit Care Med 2015; 43 (6) 1291-1325
    CrossrefPubMedGoogle Scholar
  • 6 Shemie SD, Ross H, Pagliarello J , et al; Pediatric Recommendations Group. Organ donor management in Canada: recommendations of the forum on Medical Management to Optimize Donor Organ Potential. CMAJ 2006; 174 (6, Suppl): S13-S32
    CrossrefPubMedGoogle Scholar
  • 7 Bennett EE, Sweney J, Aguayo C, Myrick C, Antommaria AHM, Bratton SL. Pediatric organ donation potential at a children's hospital. Pediatr Crit Care Med 2015; 16 (9) 814-820
    CrossrefPubMedGoogle Scholar
  • 8 Ferrera R, Hadour G, Tamion F , et al. Brain death provokes very acute alteration in myocardial morphology detected by echocardiography: preventive effect of beta-blockers. Transpl Int 2011; 24 (3) 300-306
    CrossrefPubMedGoogle Scholar
  • 9 Herijgers P, Leunens V, Tjandra-Maga TB, Mubagwa K, Flameng W. Changes in organ perfusion after brain death in the rat and its relation to circulating catecholamines. Transplantation 1996; 62 (3) 330-335
    CrossrefPubMedGoogle Scholar
  • 10 Sebening C, Hagl C, Szabo G , et al. Cardiocirculatory effects of acutely increased intracranial pressure and subsequent brain death. Eur J Cardiothorac Surg 1995; 9 (7) 360-372
    CrossrefPubMedGoogle Scholar
  • 11 Baguley IJ. Autonomic complications following central nervous system injury. Semin Neurol 2008; 28 (5) 716-725
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Kuecuek O, Mantouvalou L, Klemz R , et al. Significant reduction of proinflammatory cytokines by treatment of the brain-dead donor. Transplant Proc 2005; 37 (1) 387-388
    CrossrefPubMedGoogle Scholar
  • 13 Pratschke J, Wilhelm MJ, Kusaka M, Hancock WW, Tilney NL. Activation of proinflammatory genes in somatic organs as a consequence of brain death. Transplant Proc 1999; 31 (1–2) 1003-1005
    CrossrefPubMedGoogle Scholar
  • 14 Amado JA, López-Espadas F, Vázquez-Barquero A , et al. Blood levels of cytokines in brain-dead patients: relationship with circulating hormones and acute-phase reactants. Metabolism 1995; 44 (6) 812-816
    CrossrefPubMedGoogle Scholar
  • 15 Pullerits R, Oltean S, Flodén A, Oltean M. Circulating resistin levels are early and significantly increased in deceased brain dead organ donors, correlate with inflammatory cytokine response and remain unaffected by steroid treatment. J Transl Med 2015; 13: 201
    CrossrefPubMedGoogle Scholar
  • 16 Takada M, Nadeau KC, Hancock WW , et al. Effects of explosive brain death on cytokine activation of peripheral organs in the rat. Transplantation 1998; 65 (12) 1533-1542
    CrossrefPubMedGoogle Scholar
  • 17 Pratschke J, Neuhaus P, Tullius SG. What can be learned from brain-death models?. Transpl Int 2005; 18 (1) 15-21
    CrossrefPubMedGoogle Scholar
  • 18 Wilhelm MJ, Pratschke J, Beato F , et al. Activation of the heart by donor brain death accelerates acute rejection after transplantation. Circulation 2000; 102 (19) 2426-2433
    CrossrefPubMedGoogle Scholar
  • 19 Kusaka M, Pratschke J, Wilhelm MJ , et al. Early and late inflammatory changes occurring in rat renal isografts from brain dead donors. Transplant Proc 2001; 33 (1–2) 867-868
    CrossrefPubMedGoogle Scholar
  • 20 Land WG. The role of postischemic reperfusion injury and other nonantigen-dependent inflammatory pathways in transplantation. Transplantation 2005; 79 (5) 505-514
    CrossrefPubMedGoogle Scholar
  • 21 van der Hoeven JAB, Molema G, Ter Horst GJ , et al. Relationship between duration of brain death and hemodynamic (in)stability on progressive dysfunction and increased immunologic activation of donor kidneys. Kidney Int 2003; 64 (5) 1874-1882
    CrossrefPubMedGoogle Scholar
  • 22 Katz K, Lawler J, Wax J, O'Connor R, Nadkarni V. Vasopressin pressor effects in critically ill children during evaluation for brain death and organ recovery. Resuscitation 2000; 47 (1) 33-40
    CrossrefPubMedGoogle Scholar
  • 23 Dimopoulou I, Tsagarakis S, Anthi A , et al. High prevalence of decreased cortisol reserve in brain-dead potential organ donors. Crit Care Med 2003; 31 (4) 1113-1117
    CrossrefPubMedGoogle Scholar
  • 24 Pérez López S, Otero Hernández J, Vázquez Moreno N, Escudero Augusto D, Alvarez Menéndez F, Astudillo González A. Brain death effects on catecholamine levels and subsequent cardiac damage assessed in organ donors. J Heart Lung Transplant 2009; 28 (8) 815-820
    CrossrefPubMedGoogle Scholar
  • 25 Howlett TA, Keogh AM, Perry L, Touzel R, Rees LH. Anterior and posterior pituitary function in brain-stem-dead donors. A possible role for hormonal replacement therapy. Transplantation 1989; 47 (5) 828-834
    CrossrefPubMedGoogle Scholar
  • 26 Gramm H-J, Meinhold H, Bickel U , et al. Acute endocrine failure after brain death?. Transplantation 1992; 54 (5) 851-857
    CrossrefPubMedGoogle Scholar
  • 27 Ball SG. Vasopressin and disorders of water balance: the physiology and pathophysiology of vasopressin. Ann Clin Biochem 2007; 44 (Pt 5) 417-431
    CrossrefPubMedGoogle Scholar
  • 28 Finfer S, Bohn D, Colpitts D, Cox P, Fleming F, Barker G. Intensive care management of paediatric organ donors and its effect on post-transplant organ function. Intensive Care Med 1996; 22 (12) 1424-1432
    CrossrefPubMedGoogle Scholar
  • 29 Totsuka E, Dodson F, Urakami A , et al. Influence of high donor serum sodium levels on early postoperative graft function in human liver transplantation: effect of correction of donor hypernatremia. Liver Transpl Surg 1999; 5 (5) 421-428
    CrossrefPubMedGoogle Scholar
  • 30 Cywinski JB, Mascha E, Miller C , et al. Association between donor-recipient serum sodium differences and orthotopic liver transplant graft function. Liver Transpl 2008; 14 (1) 59-65
    CrossrefPubMedGoogle Scholar
  • 31 Bloom MB, Raza S, Bhakta A , et al. Impact of deceased organ donor demographics and critical care end points on liver transplantation and graft survival rates. J Am Coll Surg 2015; 220 (1) 38-47
    CrossrefPubMedGoogle Scholar
  • 32 Lugo N, Silver P, Nimkoff L, Caronia C, Sagy M. Diagnosis and management algorithm of acute onset of central diabetes insipidus in critically ill children. J Pediatr Endocrinol Metab 1997; 10 (6) 633-639
    PubMedGoogle Scholar
  • 33 Martikainen TJ, Kurola J, Kärjä V, Parviainen I, Ruokonen E. Vasopressor agents after experimental brain death: effects of dopamine and vasopressin on vitality of the small gut. Transplant Proc 2010; 42 (7) 2449-2456
    CrossrefPubMedGoogle Scholar
  • 34 Richardson DW, Robinson AG. Desmopressin. Ann Intern Med 1985; 103 (2) 228-239
    CrossrefPubMedGoogle Scholar
  • 35 Guesde R, Barrou B, Leblanc I , et al. Administration of desmopressin in brain-dead donors and renal function in kidney recipients. Lancet 1998; 352 (9135) 1178-1181
    CrossrefPubMedGoogle Scholar
  • 36 Blasi-Ibanez A, Hirose R, Feiner J , et al. Predictors associated with terminal renal function in deceased organ donors in the intensive care unit. Anesthesiology 2009; 110 (2) 333-341
    CrossrefPubMedGoogle Scholar
  • 37 Nozary Heshmati B, Ahmadi F, Azimi P, Tirgar N, Barzi F, Gatmiri SM. Hemodynamic factors affecting the suitability of the donated heart and kidney for transplantation. Int J Organ Transplant Med 2013; 4 (4) 150-154
    PubMedGoogle Scholar
  • 38 Pennefather SH, Bullock RE, Mantle D, Dark JH. Use of low dose arginine vasopressin to support brain-dead organ donors. Transplantation 1995; 59 (1) 58-62
    CrossrefPubMedGoogle Scholar
  • 39 Kinoshita Y, Yahata K, Yoshioka T, Onishi S, Sugimoto T. Long-term renal preservation after brain death maintained with vasopressin and epinephrine. Transpl Int 1990; 3 (1) 15-18
    CrossrefPubMedGoogle Scholar
  • 40 Chen JM, Cullinane S, Spanier TB , et al. Vasopressin deficiency and pressor hypersensitivity in hemodynamically unstable organ donors. Circulation 1999; 100 (19, Suppl): II244-II246
    PubMedGoogle Scholar
  • 41 Callahan DS, Neville A, Bricker S , et al. The effect of arginine vasopressin on organ donor procurement and lung function. J Surg Res 2014; 186 (1) 452-457
    CrossrefPubMedGoogle Scholar
  • 42 Plurad DS, Bricker S, Neville A, Bongard F, Putnam B. Arginine vasopressin significantly increases the rate of successful organ procurement in potential donors. Am J Surg 2012; 204 (6) 856-860 , discussion 860–861
    CrossrefPubMedGoogle Scholar
  • 43 Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med 2001; 344 (7) 501-509
    CrossrefPubMedGoogle Scholar
  • 44 Novitzky D, Cooper DKC, Morrell D, Isaacs S. Change from aerobic to anaerobic metabolism after brain death, and reversal following triiodothyronine therapy. Transplantation 1988; 45 (1) 32-36
    CrossrefPubMedGoogle Scholar
  • 45 Novitzky D, Cooper DKC, Reichart B. Hemodynamic and metabolic responses to hormonal therapy in brain-dead potential organ donors. Transplantation 1987; 43 (6) 852-854
    CrossrefPubMedGoogle Scholar
  • 46 Novitzky D, Cooper DKC, Chaffin JS, Greer AE, DeBault LE, Zuhdi N. Improved cardiac allograft function following triiodothyronine therapy to both donor and recipient. Transplantation 1990; 49 (2) 311-316
    CrossrefPubMedGoogle Scholar
  • 47 Pérez-Blanco A, Caturla-Such J, Cánovas-Robles J, Sanchez-Payá J. Efficiency of triiodothyronine treatment on organ donor hemodynamic management and adenine nucleotide concentration. Intensive Care Med 2005; 31 (7) 943-948
    CrossrefPubMedGoogle Scholar
  • 48 Goarin JP, Cohen S, Riou B , et al. The effects of triiodothyronine on hemodynamic status and cardiac function in potential heart donors. Anesth Analg 1996; 83 (1) 41-47
    CrossrefPubMedGoogle Scholar
  • 49 Novitzky D, Mi Z, Sun Q, Collins JF, Cooper DKC. Thyroid hormone therapy in the management of 63,593 brain-dead organ donors: a retrospective analysis. Transplantation 2014; 98 (10) 1119-1127
    CrossrefPubMedGoogle Scholar
  • 50 Callahan DS, Kim D, Bricker S , et al. Trends in organ donor management: 2002 to 2012. J Am Coll Surg 2014; 219 (4) 752-756
    CrossrefPubMedGoogle Scholar
  • 51 Zuppa AF, Nadkarni V, Davis L , et al. The effect of a thyroid hormone infusion on vasopressor support in critically ill children with cessation of neurologic function. Crit Care Med 2004; 32 (11) 2318-2322
    CrossrefPubMedGoogle Scholar
  • 52 Charmandari E, Nicolaides NC, Chrousos GP. Adrenal insufficiency. Lancet 2014; 383 (9935) 2152-2167
    CrossrefPubMedGoogle Scholar
  • 53 Oakley RH, Cidlowski JA. The biology of the glucocorticoid receptor: new signaling mechanisms in health and disease. J Allergy Clin Immunol 2013; 132 (5) 1033-1044
    CrossrefPubMedGoogle Scholar
  • 54 Pinsard M, Ragot S, Mertes PM , et al. Interest of low-dose hydrocortisone therapy during brain-dead organ donor resuscitation: the CORTICOME study. Crit Care 2014; 18 (4) R158
    CrossrefPubMedGoogle Scholar
  • 55 van Der Hoeven JAB, Ter Horst GJ, Molema G , et al. Effects of brain death and hemodynamic status on function and immunologic activation of the potential donor liver in the rat. Ann Surg 2000; 232 (6) 804-813
    CrossrefPubMedGoogle Scholar
  • 56 Kosieradzki M, Kuczynska J, Piwowarska J , et al. Prognostic significance of free radicals: mediated injury occurring in the kidney donor. Transplantation 2003; 75 (8) 1221-1227
    CrossrefPubMedGoogle Scholar
  • 57 Nijboer WN, Schuurs TA, van der Hoeven JAB , et al. Effects of brain death on stress and inflammatory response in the human donor kidney. Transplant Proc 2005; 37 (1) 367-369
    CrossrefPubMedGoogle Scholar
  • 58 McElhinney DB, Khan JH, Babcock WD, Hall TS. Thoracic organ donor characteristics associated with successful lung procurement. Clin Transplant 2001; 15 (1) 68-71
    CrossrefPubMedGoogle Scholar
  • 59 Rosendale JD, Kauffman HM, McBride MA , et al. Hormonal resuscitation yields more transplanted hearts, with improved early function. Transplantation 2003; 75 (8) 1336-1341
    CrossrefPubMedGoogle Scholar
  • 60 Dupuis S, Amiel J-A, Desgroseilliers M , et al. Corticosteroids in the management of brain-dead potential organ donors: a systematic review. Br J Anaesth 2014; 113 (3) 346-359
    CrossrefPubMedGoogle Scholar
  • 61 Dhar R, Cotton C, Coleman J , et al. Comparison of high- and low-dose corticosteroid regimens for organ donor management. J Crit Care 2013; 28 (1) 111.e1-111.e7
    CrossrefPubMedGoogle Scholar
  • 62 Mi Z, Novitzky D, Collins JF, Cooper DKC. The optimal hormonal replacement modality selection for multiple organ procurement from brain-dead organ donors. Clin Epidemiol 2015; 7: 17-27
    PubMedGoogle Scholar
  • 63 Masson F, Thicoipe M, Gin H , et al. The endocrine pancreas in brain-dead donors. A prospective study in 25 patients. Transplantation 1993; 56 (2) 363-367
    CrossrefPubMedGoogle Scholar
  • 64 Parekh J, Niemann CU, Dang K, Hirose R. Intraoperative hyperglycemia augments ischemia reperfusion injury in renal transplantation: a prospective study. J Transplant 2011; 2011: 652458
    PubMedGoogle Scholar
  • 65 Ferrera R, Ovize M, Claustrat B, Hadour G. Stable myocardial function and endocrine dysfunction during experimental brain death. J Heart Lung Transplant 2005; 24 (7) 921-927
    CrossrefPubMedGoogle Scholar
  • 66 He J, Evans CO, Hoffman SW, Oyesiku NM, Stein DG. Progesterone and allopregnanolone reduce inflammatory cytokines after traumatic brain injury. Exp Neurol 2004; 189 (2) 404-412
    CrossrefPubMedGoogle Scholar
  • 67 McNally JD, Menon K, Chakraborty P , et al; Canadian Critical Care Trials Group. The association of vitamin D status with pediatric critical illness. Pediatrics 2012; 130 (3) 429-436
    CrossrefPubMedGoogle Scholar
  • 68 McNally JD, Doherty DR, Lawson ML , et al. The relationship between vitamin D status and adrenal insufficiency in critically ill children. J Clin Endocrinol Metab 2013; 98 (5) E877-E881
    CrossrefPubMedGoogle Scholar
  • 69 McNally JD, Iliriani K, Pojsupap S , et al. Rapid normalization of vitamin D levels: a meta-analysis. Pediatrics 2015; 135 (1) e152-e166
    CrossrefPubMedGoogle Scholar