The Impact of Thyroid Hormones on Brain-Dead Organ Donors: A Systematic Review and Meta-Analysis

The administration of thyroid hormones (TH) in brain-dead donors has been proposed as a strategy to improve organ viability for transplantation, addressing the neuroendocrine insufficiency caused by brain death. While evidence suggests potential benefits, such as hemodynamic stabilization and enhanced organ function, the impact of TH replacement on donor utilization rates and transplant outcomes remains unclear.

We performed a systematic review and meta-analysis of randomized controlled trials (RCT) comparing TH administration with placebo or standard-of-care. Mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CI) were pooled using a random-effects model, and Heterogeneity was assessed using I².

Six studies involving a total of 1,197 brain-dead organ donors were included. Of these, 601 received TH, while 597 were given either a placebo or standard-of-care treatment. Overall, the number of transplanted hearts (RR 0.99; 95% CI 0.84-1.17; P = .92), lungs (RR 1.07; 95% CI 0.65-1.75; p 0.80), and livers (RR 1.00; 95% CI 0.78-1.28; P = .99) was similar between groups. Cardiac index showed no significant difference between groups (MD -0.05; 95% CI -0.28 to 0.19; P = .71), and similar trends were observed for other hemodynamic parameters, including heart rate (MD 5.11; 95% CI -1.47 to 11.69; P = .13), pulmonary capillary wedge pressure (MD -0.02; 95% CI -1.54 to 1.50; P = .98), and central venous pressure (MD 0.76; 95% CI -0.63 to 2.14; P = .28), indicating that TH administration did not significantly alter these measures compared to placebo or standard-of-care treatment.

Our data suggest that administering TH to brain-dead potential organ donors does not effectively increase the number of organ transplants and has no impact on hemodynamic parameters.