[Prospective study of harvest-to-transplant time: proposed organization]

The cold ischaemia time of a kidney before transplantation has a negative impact on the risk of acute tubular necrosis and graft survival. This cold ischaemia time can be reduced by a different organization of harvesting, organ distribution and transplantation.

Seventy nine organ donor case files from the same hospital were reviewed from reception of the donor until transplantation. 135 renal transplantations, including 60 kidneys and 14 kidney-pancreas transplants were performed on site with organs harvested from these donors. The various phases of harvesting were studied: reception and resuscitation of the patient took 30 hours, and the diagnosis of brain death, information of the families and transfer of the donor to the operating room for harvesting took 11 hours.

The mean cold ischaemia time was 6 hours when kidney-pancreas transplantation was performed and 22 hours 30 minutes for isolated local renal transplantation. The decisive factor is the time required to obtain HLA typing, which is only performed during organ harvesting for isolated renal transplantation. HLA typing and lymph node sampling in the intensive care unit would save 7 hours.

The authors recommend that HLA typing and lymph node sampling for cross matches be performed in the intensive care unit in order to reduce the cold ischaemia time.