The cadaveric kidney and the organ shortage--a perspective review

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.