Kidney donation after cardiac death in Korea

Area of Science:

• Nephrology
• Transplantation
• Organ Donation

Background:

• Graft shortages necessitate exploring alternative organ sources.
• Organ donation after cardiac death (DCD) is a potential solution to increase allograft availability.
• Korean transplant centers face challenges with limited donor organ supply.

Purpose of the Study:

• To evaluate the outcomes of kidney transplantation using DCD grafts in Korea.
• To compare DCD kidney graft recipients with those receiving grafts from standard criteria donors (SCD) and expanded criteria donors (ECD).
• To assess the feasibility of expanding the donor pool through DCD donation.

Main Methods:

• Retrospective analysis of 446 deceased donor kidney transplant recipients from September 1995 to December 2009.
• Comparison of outcomes between DCD (n=24) and non-DCD (SCD and ECD) groups.
• Assessment of graft function, delayed graft function, primary nonfunction, and graft survival rates.

Main Results:

• DCD donors had longer intensive care unit stays and lower blood pressure than SCD/ECD donors.
• Warm ischemic time in the DCD group averaged 59.7 minutes.
• No significant differences in delayed graft function or primary nonfunction between groups.
• Serum creatinine levels were higher in ECD and DCD groups at 3 months but comparable to ECD by 6-9 months.
• Graft survival rates at 12 months were similar across all donor types (P = .737).

Conclusions:

• Kidney grafts from DCD donors demonstrate comparable short-term graft survival to SCD and ECD grafts.
• DCD kidney transplantation is a viable strategy to increase the donor pool and address organ shortages.
• Type 4 DCD donors, who die after cardiac arrest during evaluation, should be considered for organ procurement.