Welcome to the MOnIToR Study

There is a national crises involving organ transplantation which is due to the severe organ shortage and the limited options available to increase organ availability. Despite efforts to increase organ donation by using living related or unrelated donation and donation after cardiac death, donation after brain death remains the main source of organs especially for heart and lung transplantation.

The large disparity between those waiting for organs and donor organs available poses a significant public health crisis as waiting list mortality rates continue to increase.

On average 3-4 organs are recovered per donor. Hemodynamic instability of the donor is a key factor that contributes to the dismal numbers of organs procured per donor. While hemodynamic instability in potential organ donors is caused by several factors, resuscitation with fluids, vassopressors and inotropes is the only practical and effective way to improve organs procurement per donor.

We plan to answer the fundamental question: “Can early protocol-guided donor resuscitation after brain death improve organ yield for transplantation?” We aim to address the overarching hypothesis that there are ‘golden hours’ after brain death wherein prompt, rigorous, and standardized donor hemodynamic management can reduce organ injury and improve viability for transplantation.

Our efforts are motivated by our findings that 50% of organ donors are fluid under-resuscitated after brain death. We have demonstrated using pulse pressure variation, a validated and precise hemodynamic monitoring parameter, that fluid under-resuscitated donors have a significantly higher inflammatory response and donate fewer organs when compared to adequately resuscitated donors. Equally, excessive fluid resuscitation risks injury to the lungs and by extension other organs.