Routine use of corticoids became standard therapy

Brain death patients who are selected for organ donation very often suffer from haemodynamic instability. To treat this, high amounts of vasoactive drugs(norepinephrine) may be needed to raise blood pressure. However,norepinephrine may have negative influence on several organs causing reduced blood flow ischemia. Our hypothesis is that hydrocortisone treatment may reduce the amount of vasoactive drugs needed to keep the blood pressure stable in patients selected for organ donation.

When patients are treated in the ICU only as possible organ donators they will be assessed for eligibility for the study. Iv hydrocortisone or placebo will be administered every 6 hours. Several hormonal samples will be collected.

Inclusion Criteria: all have to be fulfilled

• severe brain injury or subarachnoid hemorrhage which progrediates to brain death and patients are treated only as candidates for organ donation in the ICU
• no other reasons for treatment than organ donation
• informed consent from official representative

Exclusion Criteria:

• age under 18
• pregnancy
• corticoid treatment before study entry
• adrenal insufficiency
• hypophyseal insufficiency
• treatment with etomidate one week before study entry
• participating in an other study
• no informed consent