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Updated: Aug 31, 2026
Heterotopic Renal Autotransplantation in a Porcine Model: A Step-by-Step Protocol
Published on: February 21, 2016
Experiences learned in the successful establishment of a nonheart beating donor program for renal transplantation
D Talbot1, B K Shenton, P E Buckley
1Freeman Hospital, High Heaton, Newcastle upon Tyne, United Kingdom.
Purpose:
With the continuing shortage of suitable donors increasing interest is being shown in nonheart beating donation. Such a resource is a new and, therefore, an underused source of donor organs. However because of the nature of such donors, the kidneys so derived have been damaged by primary warm ischemia, and so potentially they may never function. We introduced viability testing to identify such organs and, thus, avoid transplantation. We reviewed sentinel cases in our developing program from which we have learned.
Materials And Methods:
Machine perfusion was developed locally and used to test the kidneys derived from such donors. Flow characteristics and enzyme analysis were used to define usable kidneys. The definitions of acceptable criteria evolved through the study during a 3-year period.
Results:
As previously defined, acceptable criteria were initially adhered with decreasing resistance and a glutathione S-transferase of less than 200 IU/l/100 gm. After the series described acceptable limits were changed in favor of a high perfusion flow index, low temperature, low weight increase and low glutathione S-transferase.
Conclusions:
If such criteria are adhered to, graft survival becomes reliable from such donors.
Insights
Viability testing for non-heart-beating donor kidneys improves transplant outcomes. Machine perfusion and enzyme analysis identify suitable organs, ensuring reliable graft survival and addressing donor shortages.
Area of Science:
- Organ transplantation
- Nephrology
- Surgical innovation
Background:
- Increasing organ donor shortages necessitate exploring alternative sources like non-heart-beating donation.
- Kidneys from non-heart-beating donors are susceptible to warm ischemia injury, potentially impacting function.
- Viability testing is crucial to identify and select suitable organs, preventing non-functional transplants.
Observation:
- Machine perfusion was developed and utilized for viability assessment of donor kidneys.
- Flow characteristics and enzyme analysis (glutathione S-transferase) were key parameters for defining kidney usability.
- Acceptable criteria evolved over a 3-year study period based on observed outcomes.
Findings:
- Initial criteria focused on decreasing resistance and glutathione S-transferase levels (<200 IU/l/100 gm).
- Refined criteria favored high perfusion flow index, low temperature, minimal weight increase, and low glutathione S-transferase.
- Adherence to established viability criteria leads to reliable graft survival.
Implications:
- Implementing standardized viability testing can optimize the use of non-heart-beating donor kidneys.
- This approach enhances the reliability of kidney transplantation from marginal donors.
- Improved organ utilization through viability testing can help alleviate donor shortages.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure
01:16Kidney Transplant III: Nursing Management