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January 20, 2010

Donor Dopamine Pretreatment and Graft Function After Kidney Transplantation—Reply

JAMA. 2010;303(3):230-232. doi:10.1001/jama.2009.1997

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.