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Non-heart-beating organ donors as a source of kidneys for transplantation: a chart review
1Department of Surgery, University of Calgary.
Background:
Organ transplantation is the treatment of choice for patients with end-stage organ failure, but the supply of organs has not increased to meet demand. This study was undertaken to determine the potential for kidney donation from patients with irremediable brain injuries who do not meet the criteria for brain death and who experience cardiopulmonary arrest after withdrawal of ventilatory support (controlled non-heart-beating organ donors).
Methods:
The charts of 209 patients who died during 1995 in the Emergency Department and the intensive care unit at the Foothills Hospital in Calgary were reviewed. The records of patients who met the criteria for controlled non-heart-beating organ donation were studied in detail. The main outcome measure was the time from discontinuation of ventilation until cardiopulmonary arrest.
Results:
Seventeen potential controlled non-heart-beating organ donors were identified. Their mean age was 62 (standard deviation 19) years. Twelve of the patients (71%) had had a cerebrovascular accident, and more than half (10 [59%]) did not meet the criteria for brain death because one or more brain stem reflexes were present. At the time of withdrawal of ventilatory support, the mean serum creatinine level was 71 (29) mumol/L, mean urine output was 214 (178) mL/h, and 9 (53%) patients were receiving inotropic agents. The mean time from withdrawal of ventilatory support to cardiac arrest was 2.3 (5.0) hours; 13 of the 17 patients died within 1 hour, and all but one died within 6 hours. For the year for which charts were reviewed, 33 potential conventional donors (people whose hearts were beating) were identified, of whom 21 (64%) became donors. On the assumption that 40% of the potential controlled non-heart-beating donors would not in fact have been donors (25% because of family refusal and 15% because of nonviability of the organs), there might have been 10 additional donors, which would have increased the supply of cadaveric kidneys for transplantation by 48%.
Interpretation:
A significant number of viable kidneys could be retrieved and transplanted if eligibility for kidney donation was extended to include controlled non-heart-beating organ donors.
Insights
Extending kidney donation eligibility to controlled non-heart-beating organ donors could significantly increase the organ supply. This approach may yield approximately 10 additional donors, boosting cadaveric kidney availability by 48%.
Area of Science:
- Nephrology
- Transplant Surgery
- Critical Care Medicine
Background:
- Organ transplantation is crucial for end-stage organ failure but faces supply shortages.
- Current donor criteria limit the pool of available organs.
- This study explores donation potential from patients with severe brain injuries not meeting brain death criteria.
Purpose of the Study:
- To assess the viability of kidney donation from controlled non-heart-beating organ donors.
- To determine the potential increase in cadaveric kidney supply through this donor category.
Main Methods:
- Retrospective review of 209 patient deaths in 1995 at Foothills Hospital.
- Detailed analysis of patients meeting criteria for controlled non-heart-beating organ donation.
- Measurement of time from ventilation withdrawal to cardiopulmonary arrest.
Main Results:
- 17 potential controlled non-heart-beating organ donors were identified (mean age 62).
- 10 (59%) did not meet brain death criteria due to preserved brainstem reflexes.
- Mean time to cardiac arrest post-ventilation withdrawal was 2.3 hours; 13/17 died within 1 hour.
- Estimated potential for 10 additional donors, increasing cadaveric kidney supply by 48%.
Conclusions:
- Controlled non-heart-beating organ donors represent a significant, largely untapped resource.
- Expanding eligibility criteria could substantially improve kidney transplant waiting lists.
- Viable kidneys can be retrieved from this donor population for transplantation.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure