Management of the brain-dead organ donor: a systematic review and meta-analysis

Transplantation. 2013 Apr 15;95(7):966-74. doi: 10.1097/TP.0b013e318283298e.


Background: The shortage of organs is a limitation for transplantation, making the care of potential organ donors an important issue. The present systematic review and meta-analysis was carried out to assess the efficacy of interventions to stabilize hemodynamics in brain-dead donors or to improve organ function and outcomes of transplantation.

Methods: Medline, Embase, and Cochrane databases were searched. Of 5096 articles retrieved, 39 randomized controlled trials were selected. Twenty were included in a qualitative synthesis, providing data on 1277 patients. The main interventions described were desmopressin use, triiodothyronine and methylprednisolone replacement, fluid management, vasopressor therapy, mechanical ventilation strategies, and surgical techniques.

Results: Three meta-analyses were conducted: the first included two studies and showed that desmopressin administered to brain-dead patients was not advantageous with respect to early organ function in kidney recipients (relative risk, 0.97; 95% confidence interval [CI], 0.85-1.10; I(2) = 0%; P = 0.809). The second included four studies and showed that triiodothyronine did not add hemodynamic benefits versus standard management (weighted mean difference, 0.15; 95% CI, -0.13 to 0.42; I(2) = 17.4%; P = 0.304). The third meta-analysis (two studies) showed that ischemic liver preconditioning during harvesting procedures did not benefit survival (relative risk, 1.0; 95% CI, 0.93-1.08; I(2) = 0%; P = 0.459).

Conclusion: The present results suggest limited efficacy of interventions focusing on the management of brain-dead donors.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Brain Death* / metabolism
  • Brain Death* / physiopathology
  • Deamino Arginine Vasopressin / administration & dosage
  • Fluid Therapy
  • Hemodynamics
  • Hormone Replacement Therapy
  • Humans
  • Methylprednisolone / administration & dosage
  • Respiration, Artificial
  • Tissue Donors / supply & distribution*
  • Tissue and Organ Harvesting / methods
  • Tissue and Organ Procurement*
  • Transplants* / adverse effects
  • Triiodothyronine / administration & dosage
  • Vasoconstrictor Agents / administration & dosage


  • Vasoconstrictor Agents
  • Triiodothyronine
  • Deamino Arginine Vasopressin
  • Methylprednisolone