Table 2.

Commonly used drug regimens for endocrine management of the brain-dead organ donor

Hormone/drug	Dose	Remark	Evidence
Thyroid hormone
Thyroxine (T4)	20 µg IV bolus	Precursor of T3	More organs procured in observational studies [37]
	10 µg/h IV maintenance	Low intrinsic biological activity	No proof in benefit in RCTs [38]
		Increased conversion into inactive rT3
		Slow onset
Triiodothyronine (T3)	4 µg IV bolus	Active hormone	More organs procured in observational studies [37]
	3 µg/h IV maintenance	Rapid onset	No proof in benefit in RCTs [38]
		May trigger arrhythmias
Corticosteroid
Methylprednisolone	1000 mg IV od	Monitor blood glucose levels	Improved donor hemodynamics, increased organ procurement. and improved graft and recipient survival in some observational studies [37, 40]
	OR	Only after blood sampling for tissue typing	Mixed results from RCTs, largely neutral [40]
	15 mg/kg IV od
	OR
	250 mg IV bolus
	100 mg/h IV maintenance
Hydrocortisone	50 mg IV bolus	Monitor blood glucose levels	Lower vasopressor need in observational study, without difference in organ procurement rate [41]
	10 mg/h IV maintenance	Only after blood sampling for tissue typing	No RCT evidence
	OR
	300 mg/d IV
Insulin	Continuous IV infusion	Frequently measure blood glucose	Supported by observational studies [8, 42]
	Adjust dose to preset target blood glucose	At least avoid severe hyperglycaemia and large blood glucose fluctuations	No RCT evidence in this population

IV intravenous, od once daily, RCT randomized controlled trial, rT3 reverse-T3