Venkateswaran, R.V. (2010)
M.D. thesis, University of Birmingham.
Heart and lung transplantation activity is frustrated by the lack of availability of donor organs. The haemodynamic, hormonal and inflammatory changes that follow brain stem death leads to donor organ injury. Appropriate donor management is essential to avoid further damage to already injured donor heart and lungs. Hormone replacement therapy with tri-iodothyronine and methylprednisolone in organ donors has been reported to increase the retrieval rate of heart and lungs with improved function. In a prospective, randomised, double blind, controlled trial the role of hormone replacement therapy and early donor management on the donor heart and lung function and their retrieval rate was studied. Heart donor Outcome Early donor management was associated with significant improvement in donor heart function. It may also increase the retrieval rate of hearts for transplantation. However, administration of hormones neither influenced the donor heart function nor the heart retrieval rate. Serial echocardiography guides in identifying suitable donor hearts for transplantation during intensive management. Lung donor outcomes Early donor management was associated with significant increase in lung retrieval rate for transplantation. Despite management donor lung function deteriorated following brain stem death. Hormone replacement therapy did not increase the lung retrieval rate or affect the donor lung function. However, methylprednisolone administration leads to significant reduction in progressive donor lung water accumulation. Measurement of thermodilution lung water index predicted ultimate lung suitability for transplantation and recipient outcome. Conclusion Early donor management is the cornerstone to improve the donor heart function and to increase the lung retrieval rate. It may also increase the heart retrieval rate. Serial transthoracic echocardiography may guide in identifying suitable hearts that respond to donor management.
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