In a groundbreaking clinical trial conducted by researchers at Washington University School of Medicine in St. Louis and Mid-America Transplant, it has been revealed that the routine practice of treating deceased organ donors with thyroid hormones does not yield the expected benefits and may, in fact, lead to harm.
The findings, published in The New England Journal of Medicine on Nov. 30, challenge the widespread adoption of this practice and emphasize the importance of critically assessing interventions to enhance organ viability for transplantation. Dr. Raj Dhar, a professor of neurology at Washington University and an attending physician in the Neurology/Neurosurgery Intensive Care Unit at Barnes-Jewish Hospital, serves as the corresponding author on the paper.
Alongside Dr. Gary Marklin, the chief medical and research officer at Mid-America Transplant, the study aimed to address the dearth of rigorous research on preserving organ function for donation, especially given the ongoing shortage of donor organs for transplantation. Â
Despite thyroid hormone intervention being a common practice, often administered intravenously to thousands of organ donors annually, the study results indicate that it does not confer the anticipated benefits and, in some cases, may cause harm. This revelation raises concerns about the standard protocols followed by organ-procurement organizations nationwide. Â
Dr. Dhar stressed the critical need for preserving organ function, especially considering the scarcity of donor organs available for transplantation. The study investigated the impact of intravenous thyroid hormone on heart function, with a particular focus on increasing the quantity and quality of hearts suitable for transplantation. However, the findings suggest that this intervention lacks efficacy and may even pose risks to the health of donors’ hearts and other organs. Â
The research team, comprising experts from 15 organ-procurement organizations across the nation, enrolled 838 organ donors who had been declared dead according to neurological criteria. Half of the participants received levothyroxine, a synthetic form of the human thyroid hormone T4, within the first 24 hours, while the other half received a saline solution.
The study, spanning four years, aimed to provide definitive answers regarding the impact of thyroid hormone supplementation on heart function and the availability of transplantable hearts. The results showed that thyroid hormone treatment did not significantly increase the number of hearts successfully transplanted.
Both the thyroid hormone group and the placebo group had similar percentages of hearts deemed suitable for transplantation. Moreover, after 30 days, the functionality of transplanted hearts from both groups exhibited minimal differences, indicating that thyroid hormone intervention did not confer a lasting advantage. Notably, the study revealed that thyroid hormone treatment was more likely to cause adverse effects such as hypertension and a fast heart rate.
These effects were mitigated when hormone doses were reduced or discontinued, suggesting a potential for temporary overstimulation of the heart. Given these findings, the researchers advocate for discontinuing the routine use of thyroid hormone in the treatment of organ donors, urging a reassessment of organ donor management practices. Â
In response to the study’s outcomes, several organ-procurement organizations have already ceased the use of thyroid hormone in the treatment of organ donors, marking a significant shift in standard practices within the field. The researchers emphasize the importance of continued exploration and scrutiny of such interventions to ensure optimal outcomes for patients in need of organ transplants. Â
Journal Reference Â
Dhar, R., Marklin, G. F., Klinkenberg, W. D., Wang, J., Goss, C. W., Lele, A. V., … Lebovitz, D. J. (2023). New England Journal of Medicine, 389(22), 2029–2038. doi:10.1056/nejmoa2305969Â
