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The cadaveric kidney and the organ shortage--a perspective review
L Brasile1, B Stubenitsky, M Booster
1University of Maastricht, Faculty of Medicine, Maastricht, The Netherlands. breonics@global2000.net
Abstract:
Despite the technical and logistical hurdles that must be overcome with the reintroduction of non-heartbeating donor kidneys, the potential of these organs represents the only near-term solution for effectively alleviating the growing disparity between demand and supply. This review provides an argumentative overview of the history of cadaveric kidney transplantation. During the early years of transplantation retrieval of kidneys from non-heartbeating donors necessitated a prolonged period of warm ischemic exposure, with a corresponding minimal ex vivo period since organ preservation was in its infancy. Today we have the inverse situation where warm ischemic times are quite limited and hypothermic preservation times average 24 h because organs are shipped to remote centers due to mandated organ sharing algorithms. The recent experience with the reintroduction of non-heartbeating donors has necessitated combining the worst aspects from both eras: substantial warm ischemia with prolonged hypothermic preservation. Nevertheless, recent results from several transplant groups poignantly highlight the potential of this approach in expanding the organ donor pool.
Insights
Reintroducing non-heartbeating donor kidneys is crucial for addressing the organ shortage. Despite challenges, this approach shows promise for expanding the kidney donor pool and improving transplantation outcomes.
Area of Science:
- Nephrology
- Transplantation immunology
- Organ preservation
Background:
- The demand for kidney transplants significantly exceeds the supply of available organs.
- Cadaveric kidney transplantation has evolved, with shifts in donor criteria and organ preservation techniques.
- Non-heartbeating donors (NHBDs) offer a potential solution to the organ shortage, but present unique challenges.
Purpose of the Study:
- To provide an argumentative overview of the history of cadaveric kidney transplantation.
- To examine the evolution of organ retrieval and preservation for non-heartbeating donor kidneys.
- To highlight the potential of NHBDs in expanding the donor pool.
Main Methods:
- Review of historical data and contemporary practices in kidney transplantation.
- Analysis of changes in warm ischemia times and hypothermic preservation durations.
- Examination of outcomes associated with reintroducing non-heartbeating donors.
Main Results:
- Early NHBD transplantation involved prolonged warm ischemia and minimal preservation.
- Current practices often involve limited warm ischemia but extended preservation due to organ sharing mandates.
- Recent reintroduction of NHBDs combines substantial warm ischemia with prolonged preservation, yet shows promising results.
Conclusions:
- Non-heartbeating donor kidneys are a vital near-term solution to the organ supply-demand gap.
- Overcoming technical and logistical hurdles is essential for successful NHBD transplantation.
- Despite historical and current challenges, NHBDs hold significant potential for expanding the organ donor pool.