The detailed hormonal replacement combinations for each organ type and multiple organ procurement are summarized in Table 4. Hormonal replacement therapy has been widely used to increase organ procurement from human brain-dead donors.
1– 7 Although there are reports demonstrating that combination hormonal therapy can significantly increase the number of organs that can be procured from each brain-dead potential donor, the optimal regimen that maximizes multiple organ procurement and improves organ quality remains uncertain.
This study was also conducted in accordance with French law concerning multiple organ procurement.
A1 was the best modality for multiple organ procurement, but was not significantly better than A2 and A4.
We selected the best hormonal replacement modality for successful multiple organ procurement using a two-step approach.
To select the optimal modality for single and multiple organ procurement, multiple comparison procedures (MCA, MCC, and MCB) were applied based on the logits from either the logistic regressions or generalized linear mixed models (GLMM).
Based on the available UNOS data, and using the proposed best treatment selection method, we cautiously recommend that the combination of all four hormones is the optimal modality for multiple organ procurement for transplantation.
Although there was some variation in the optimal combination of hormones for a specific organ, the combination of thyroid hormone, a corticosteroid, antidiuretic hormone, and insulin was the optimal hormonal therapy to maximize multiple organ procurement.
The use of inotropic agents and replacement of depleted hormones (hormonal replacement therapy) is crucial for successful multiple organ procurement, yet the optimal hormonal replacement has not been identified, and the statistical adjustment to determine the best selection is not trivial.
Based on 10-year data from the United Network for Organ Sharing (UNOS), among 16 hormonal replacement modalities, and using the 95% simultaneous confidence intervals, we found that the combination of thyroid hormone, a corticosteroid, antidiuretic hormone, and insulin was the best modality for multiple organ procurement for transplantation.
