Thyroid hormone resuscitation after brain death in potential organ donors: A primer for neurocritical care providers and narrative review of the literature

Solid organ transplantation has become a mainstay in the contemporary management of end-stage organ failures fueled by advances in immunosuppression, intensive care and surgical technology. Every year, a vast number of transplantable organs is lost on account of hemodynamic instability in potential brain-dead organ donors. Because of a growing organ shortage, measures that increase total donor supply pools are desperately needed. Thyroid hormone has been identified as an adjunctive therapy in donor management due to its potential for increasing organ supply and is currently endorsed by transplant organizations such as United Network for Organ Sharing (UNOS). Much of the evidence in support of thyroid hormone comes from level III studies showing greater donor survival and procurement rates. However, all prospective randomized studies to date have failed to corroborate any such benefit. Here, we describe the role of thyroid hormone in transplantation medicine and summarize data on its putative contributions to circulatory stability, organ yield and long-term graft function. At present, level I studies do not exist and many level II studies, which do not endorse its use, are of poor quality. Further research, particularly large-scale multi-center trials are therefore warranted to shed light on this matter.