Donor Dopamine Pretreatment and Graft Function After Kidney Transplantation—Reply

In Reply: Dr Silverstein raises concerns about the ethical rationale for not having obtained informed consent for study inclusion from the transplant recipients. Before the prospective dopamine trial was initiated, we had undertaken a large registry-based cohort study¹ that failed to demonstrate any negative effects of donor dopamine treatment but indicated a dose-dependent improvement on graft survival after kidney transplantation associated with catecholamine use, including dopamine. These findings were confirmed by another independent retrospective cohort study from our center.² These retrospective studies also support that the prospective trial was carried out according to common practice in the management of a deceased heart beating donor, with the only difference that dopamine was administered under the surveillance of a controlled clinical trial. Moreover, current guidelines for the management of a brain-dead organ donor advocate the administration of dopamine or dobutamine up to a dosage of 10 μg/kg/min to maintain hemodynamic stability.³ Dopamine was administered at a dosage of 4 μg/kg/min, and both dopamine-treated donors and controls were carefully monitored to meet the target parameters of hemodynamic stability, so that irrespective of study assignment all donors were treated according to present guidelines.