Intravenous Levothyroxine for Unstable Brain-Dead Heart Donors
NEJM, 2023 · Multicenter randomized trial across 15 organ-procurement organizations (838 donors in the primary analysis)
Clinical question
Does routine IV levothyroxine increase heart transplantation from hemodynamically unstable potential heart donors after death by neurologic criteria?
What the trial found
Routine levothyroxine did not increase the proportion of donor hearts transplanted.
Current guideline position
Important contemporary RCT that challenges routine empiric thyroid-hormone replacement in unstable potential heart donors.
Clinical interpretation
Do not teach universal thyroid-hormone replacement after death by neurologic criteria as an evidence-based organ-yield intervention; use donor-team protocols and patient-specific indications.
2023 AAN/AAP/CNS/SCCM consensus guideline: prerequisites, brainstem reflex examination, apnea testing on and off ECMO, valid ancillary tests, plus separate post-declaration donor-management principles.
Ethically separated death determination, timely organ-procurement referral, and physiology-focused donor support after BD/DNC or planned donation after circulatory death.