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Hormone replacement before brain death increases organ donation rate after catastrophic brain injury: An EAST
Kristen D Nordham1, Danielle Tatum, Mayur B Patel
1Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA (K.D.N., J.A.K., A.N.H, A.K., R.N., ); Department of Surgery, Tulane University School of Medicine, New Orleans, LA (K.D.N., D.T., A.P., E.L., B.M.L., E.C., R.M.B., S.A.Z., K.N.H., J.Z., S.T.); Department of Surgery, Vanderbilt University Medical Center, Nashville, TN (M.B.P., A.W.M., A.B.P.); John W. Deming Department of Medicine, Division of Biomedical Informatics and Genomics,Tulane University School of Medicine,(New Orleans, LA (L.G., S.H.); Department of Surgery, University of Mississippi Medical Center, Jackson, MS (J.C.D.); Department of Surgery, University of California- Irvine, Orange, CA (J.N); Department of Surgery, Arrowhead Regional Medical Center, Colton, CA (B.W., J.S.); Department of Surgery, WakeMed Health & Hospitals, Raleigh, NC (P.O.U., A.S., C.S.); Department of Surgery, UT Health Tyler, Tyler, TX (A.E., J.M., B.P.); Department of Surgery, Medstar Georgetown Washington Hospital Center, Washington, DC (E.C.); Department of Surgery, The University of Chicago, Chicago, IL (R.M.B.); Department of Surgery, Mercy Health-St. Vincent Medical Center, Toledo, OH (S.A.Z.); Department of Surgery, Louisiana State University Health, New Orleans, LA (B.H.S.); Department of Surgery, Cooper University Hospital, Camden, NJ (T.E.I.A.); Cooper Medical School of Rowan University, Camden, NJ (P.M., J.M.); Lehigh Valley Health Network, Department of Surgery (Allentown, PA) (M.S.F., M.D.P.); Department of Surgery, Valleywise Health Medical Center, Phoenix, AZ (C.T., P.S.T.M.); Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA (J.D.S.); Department of Surgery, Ascension St. Vincent Hospital, Indianapolis, IN (L.E.J., J.M.W.); Department of Surgery, Emory University School of Medicine, Atlanta, GA (J.D.S.); Department of Surgery, University of Connecticut School of Medicine, Hartford Hospital, Hartford, CT (P.K.); Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA (R.H., D.G.); Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX (A.S., C.V.B. J.V.); Department of Surgery, King Saud Medical City, Riyadh, Saudi Arabia (S.M.C., F.A.); Ascension Via Christi Hospitals Wichita Trauma Services (Wichita, KS) (J.M.H., K.L.); Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA (J.A.M., D.R.); Department of Surgery, Inova Health System, Falls Church, VA (D.T., E.T.); Department of Surgery, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA (T.H.J., G.D.); Department of Surgery, University of Kentucky Healthcare, Lexington, KY (A.C.B., B.S.); Department of Surgery, Conemaugh Memorial Medical Center, Johnstown, PA (S.L.M., N.P.); Department of Surgery, Bronson Methodist Hospital, Kalamazoo, MI (R.S., S.W.); Department of Surgery, North Memorial Health Hospital, Minneapolis, MN (B.S.M., M.A.W.); Department of Surgery, Los Angeles General Medical Center, Los Angeles, CA (K.M., S.P.); Department of Surgery, Warren Alpert Medical School at Brown University, Providence, RI (S.L.N.); Department of Surgery, Loyola University Chicago, Maywood, IL (M.H., V.D.); Department of Surgery, Spartanburg Medical Center, Spartanburg, SC (C.M., T.J.M.); Department of Surgery, Tufts Medical Center, Boston, MA (N.B., W.B.); Department of Surgery, University of Tennesee College of Medicine Chattanoga, Chattanoga, TN (R.J.J., R.C.H.); Department of Surgery, HCA Research Medical Center, Kansas City, MO (M.J.L., H.M.D.); Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX (R.P.D.); Baylor College of Medicine Houston, TX (C.A.F.); Department of Surgery, University of Nebraska Medical Center, Omaha, NE (W.T.H.T., Y.T.); Department of Surgery, General University Hospital of Patras, Pio, Greece (V.M.F.M.); Department of Surgery, Broward Health Medical Center, Fort Lauderdale, FL (J.D.B., D.R.M.); Department of Surgery, South Texas Health System McAllen, McAllen, TX (C.H.P., M.B.A.); Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC (N.M.G., J.F.).
Insights
Hormone replacement therapy (HRT) significantly increases organ donation rates in patients with catastrophic brain injury (CBI). A standardized HRT protocol could maximize organ recovery in trauma patients.
Area of Science:
- Trauma Surgery
- Neurosurgery
- Organ Donation Science
Background:
- Catastrophic brain injury (CBI) leads to physiological derangements, potentially preventing organ donation in one-third of donors.
- Hormone replacement therapy (HRT) shows promise in mitigating CBI-related organ damage.
- No standardized HRT protocol exists for trauma centers, hindering its widespread application.
Purpose of the Study:
- To investigate the association between HRT and organ donation in CBI patients.
- To identify which hormone combinations are most beneficial for increasing organ donation rates.
Main Methods:
- A prospective, observational, multicenter trial (EAST multicenter trial) involving 1,184 adult CBI patients across 38 trauma centers.
- Generalized linear mixed model (GLMM) analysis to assess the association of HRT with organ donation, controlling for demographic and clinical factors.
- Data collected from January 2022 to June 2025.
Main Results:
- Of 1,184 CBI patients, 704 received HRT, and 227 of 269 organ donors received HRT.
- Single-hormone HRT (steroids, levothyroxine, vasopressin, dopamine, DDAVP, insulin) was associated with increased odds of organ donation.
- The combination of methylprednisolone and levothyroxine demonstrated the greatest increase in organ donation odds.
Conclusions:
- HRT administered before brain death significantly increases the likelihood of organ donation in CBI patients.
- Implementing a standardized HRT protocol in trauma centers is recommended to maximize organ recovery.
- This approach can optimize organ availability for patients requiring transplants.
Background:
One third of organ donors die due to catastrophic brain injury (CBI). CBI causes massive physiological derangements that can damage organs and prevent organ donation. Hormone replacement therapy (HRT) can mitigate this damage when given in the critical care setting, but no standardized protocol for use at trauma centers exists. Single-center studies show that HRT increases organ donation, but there has not been an investigation on which hormone combinations are most beneficial.
Methods:
This prospective, observational EAST multicenter trial included adult CBI patients at 38 Level I and II trauma centers from January 2022 to June 2025. CBI was defined as a brain injury causing loss of function above the brain stem and subsequent death. A generalized linear mixed model analyzed the association of HRT and organ donation.
Results:
Of 1,184 CBI patients, 704 received at least one hormone. There were 269 organ donors, and 227 received HRT. HRT patients were younger, more often male, sustained higher rates of penetrating brain injuries, and had lower rates of known comorbidities compared with non-HRT patients. HRT patients had higher ISS, but there was no difference in abbreviated injury scale-head scores between groups. GLMM analysis accounted for demographic and clinical differences between groups and found that single-hormone replacement with steroids, levothyroxine, vasopressin, dopamine, DDAVP, or insulin was associated with increased odds ratios of organ donation compared with no HRT. The combination of methylprednisolone and levothyroxine was associated with the greatest increased odds of donation.
Conclusions:
When administered to CBI patients before brain death, HRT is associated with significantly increased odds of organ donation. A standardized protocol incorporating HRT should be utilized across trauma centers to maximize organ donation in patients who have suffered nonsurvivable head trauma. ( J Trauma Acute Care Surg . 2026;00: 000-000 Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved.).
Level Of Evidence:
Prognostic and Epidemiological; Level II.

