The study, led by Hasan Sarıtaş of Siirt University and Meral Özkan of Inönü University, enrolled 90 living liver donors at a university liver transplant institute in Eastern Turkey between August 2021 and February 2022. Participants were randomly assigned in equal groups of 30 to one of three conditions: a music group, a silence group, and a control group. Donors in the music group listened to 30 minutes of patient-preferred music during the intraoperative period, with playback starting simultaneously with anesthesia induction. The researchers recorded hemodynamic parameters and serum cortisol levels before and after the intervention, allowing them to track how each group’s physiology changed across the surgical window.

The physiological logic behind the trial rests on the well-documented connection between the auditory system and the autonomic nervous system. Even under general anesthesia, the body’s neuroendocrine machinery responds to surgical stress by releasing cortisol from the adrenal cortex, driven by the hypothalamic-pituitary-adrenal axis. Cortisol, in turn, contributes to elevations in heart rate and blood pressure, increases in respiratory drive, and broader hemodynamic lability. Music therapy researchers have long hypothesized that auditory input can dampen this cascade, potentially through modulation of limbic system activity and reduced sympathetic outflow. Testing that hypothesis in the demanding context of living liver donation, where surgical stress is substantial, offered a rigorous setting in which any measurable effect would be clinically meaningful.

When the researchers compared the three groups directly at the posttest, the headline hemodynamic parameters did not differ significantly between groups, with p-values exceeding 0.05. That null result matters, and the authors are careful not to overstate their case. However, within-group analyses told a more nuanced story. Significant changes across time appeared in selected parameters in each group, and the most pronounced reductions in pulse rate, systolic blood pressure, and cortisol were observed in the music group. In other words, while the music did not produce a dramatic between-group separation on every measure, donors who heard their preferred music showed the steepest declines in the very markers most closely tied to surgical stress.

The statistical analysis of group-by-time interactions sharpened the picture further. For pulse rate, systolic blood pressure, and cortisol, the interaction between group assignment and time was statistically significant, with p-values below 0.05, indicating that the trajectory of these measures over the intervention period differed depending on whether a donor heard music, sat in silence, or received standard care. By contrast, diastolic blood pressure, respiratory rate, and oxygen saturation showed no significant group-by-time interactions, suggesting that music’s influence, if real, is selective rather than universal. The researchers interpret this pattern as evidence that patient-preferred music administered during the intraoperative period may favorably influence selected stress-related physiological and endocrine responses in living liver donors, while explicitly cautioning that the lack of significant direct posttest comparisons means the findings should not be read as proof of definite clinical benefit.

Why would music reach a patient who is fully anesthetized? The question is one of the most intriguing aspects of the study. Evidence from intraoperative music research suggests that auditory processing is not entirely abolished under general anesthesia, and that intraoperative sounds can influence autonomic and endocrine outputs even when explicit awareness is absent. Patient-preferred music may be particularly effective because familiarity and personal meaning engage reward circuitry and reduce perceived threat, mechanisms that plausibly translate into attenuated sympathetic activation. In the operating room, where the clatter of instruments and the hum of monitors form a constant auditory backdrop, replacing or overlaying that environment with calming, personally chosen music could shift the body’s baseline in ways that standard care does not.

The choice of population is also significant. Living liver donors are healthy volunteers who accept substantial risk for the benefit of another person, and their perioperative experience carries both physical and psychological weight. Surgical stress in hepatic resection is considerable, and elevated cortisol and hemodynamic instability during the operation can complicate recovery. If a noninvasive, inexpensive intervention such as preferred music can modestly blunt stress markers without drugs or added risk, the implications extend beyond transplant surgery to the broader perioperative field, where music therapy has been explored for everything from anxiety reduction to postoperative pain management. The Turkish trial is among the first to examine these outcomes specifically in living liver donors, a group whose altruism makes minimizing their burden especially compelling.

The study was approved by the Malatya Clinical Research Ethics Committee at Inönü University Turgut Özal Medical Center in January 2021 and conducted in accordance with the Declaration of Helsinki, with written informed consent obtained from all participants. It was retrospectively registered on ClinicalTrials.gov under identifier NCT06997237, a detail that readers should weigh when interpreting the results, since prospective registration is generally considered methodologically stronger. The research was funded by the Inönü University Scientific Research Projects Coordination Unit under Project No. 2613, and the authors declare no competing interests. Cortisol analyses were carried out with the assistance of the institute’s Hepatology Laboratory, and data collection was supported by staff of the Liver Transplantation Institute.

For clinicians and researchers, the trial offers both encouragement and a clear agenda for future work. The selective significance of pulse rate, systolic blood pressure, and cortisol, set against null findings for diastolic pressure, respiration, and oxygen saturation, suggests that music’s physiological footprint is real but narrow, and that larger samples or more sensitive designs may be needed to detect between-group differences in hemodynamic parameters. The authors themselves emphasize cautious interpretation, and their restraint is warranted: a within-group trend, however pronounced, is not the same as a demonstrated clinical advantage over silence or standard care. Still, the safety profile of intraoperative music is essentially flawless, its cost is negligible, and its implementation requires nothing more than headphones and a playlist. In an era when perioperative medicine is searching for low-risk adjuncts that humanize the surgical experience, the idea that a donor’s favorite song might quiet the stress chemistry of liver surgery is an inviting one, and it deserves the larger, prospectively registered trials that will determine whether music can move from operating room background to evidence-based practice.

Subject of Research: The effect of intraoperative music on hemodynamic parameters and cortisol levels in living liver transplant donors

Article Title: The effects of music played to liver transplant donors during surgery on some hemodynamic parameters and cortisol levels: a randomized controlled trial

Article References: Sarıtaş, H., & Özkan, M. (2026). The effects of music played to liver transplant donors during surgery on some hemodynamic parameters and cortisol levels: a randomized controlled trial. BMC Complementary Medicine and Therapies. https://doi.org/10.1186/s12906-026-05586-x

Image Credits: AI Generated

DOI: 10.1186/s12906-026-05586-x

Keywords: liver transplantation, living donors, music therapy, cortisol, hemodynamic parameters, randomized controlled trial, anesthesia, surgical stress, intraoperative music, complementary medicine, blood pressure, pulse rate