Comparison of Dopamine and Norepinephrine for Organ Procurement Optimization in Brain-Dead Organ Donors

Dopamine and norepinephrine are the mainstay vasopressors in shock management, including brain-dead organ donors. However, only a few studies have been conducted on brain-dead organ donors. We aimed to identify the most effective vasopressor for management of hypotensive brain-dead organ donors within the final 24 hours.

We reviewed and analyzed the medical records of brain-dead organ donors from January 2010 to December 2023. We calculated the total amount of vasopressor used during the last 24 hours as equivalent dosages by using the vasoactive inotropic score. We classified the brain-dead organ donors into 2 groups: dopamine-predominant and norepinephrine-predominant deceased donors. The primary outcome measure was the rate of organ procurement, and the secondary outcome measures were organ function and physiological status.

We included 102 brain-dead organ donors: 67 (65.7%) in the dopamine-predominant group and 35 (34.3%) in the norepinephrine-predominant group. Liver grafts were procured from 94 brain-dead organ donors (92.2%). The dopamine-predominant group showed significantly higher rates of liver procurement (98.5% vs 80.0%; P = .002). Multivariate logistic regression analysis demonstrated that significantly more liver grafts were procured in the dopamine-predominant group than in the norepinephrine-predominant group (odds ratio 14.642; P = .015).

Dopamine-predominant vasopressor therapy can better alleviate anaerobic metabolism and augment the rates of liver procurement.