Organ donors: heartbeating and non-heartbeating

Area of Science:

• Transplantation Medicine
• Nephrology
• Organ Donation

Background:

• Organ donation from heart-beating (HB) donors has plateaued, with initiatives like the European Donor Hospital Education Program (EDHEP) failing to significantly increase kidney and other organ availability.
• The use of marginal donors (e.g., those with horseshoe kidneys, extremes of age, or diabetes) is proposed as a strategy to expand the donor pool.
• Non-heart-beating (NHB) donation is explored as an additional source, particularly for kidneys.

Purpose of the Study:

• To investigate strategies for expanding the organ donor pool beyond traditional heart-beating (HB) donors.
• To evaluate the feasibility and utility of non-heart-beating (NHB) donors for organ transplantation, focusing on kidneys.
• To assess the role of viability testing in selecting organs from NHB donors.

Main Methods:

• Expanded the kidney donor pool by incorporating non-heart-beating (NHB) donors.
• Utilized a preservation machine for NHB kidneys to enable viability testing.
• Employed glutathione S-transferase (GST) as a biomarker to assess tubular damage and guide transplantation decisions for NHB kidneys.

Main Results:

• The kidney donor pool was significantly enlarged through the inclusion of NHB donors.
• Viability testing of preserved NHB kidneys, using GST levels to measure tubular damage, allows for informed decisions on transplant suitability.
• NHB donation appears viable for kidneys and potentially livers with short warm ischemia times, but less so for other organs.

Conclusions:

• Non-heart-beating (NHB) donors represent a crucial resource for increasing kidney transplantation rates.
• Viability assessment using biomarkers like glutathione S-transferase (GST) is essential for optimizing the use of NHB donor kidneys.
• Further research into NHB donation for organs other than kidneys and livers may be limited by ischemia time considerations.