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Do we need a different organ allocation system for kidney transplants using donors after circulatory death?
Shanka K Benaragama1, Teressa Tymkewycz, Biku J John
1UCL Centre for Nephrology, Royal Free hospital, London, UK. shanka.benaragama@nhs.net.
Insights
Sequential transplantation of kidneys from Donation after circulatory death (DCD) donors in the UK leads to longer cold ischemia times and increased risk of delayed graft function for the second kidney. This practice should be avoided.
Area of Science:
- Nephrology
- Transplantation Surgery
- Organ Donation
Background:
- The UK lacks a national policy for allocating kidneys from Donation after circulatory death (DCD) donors.
- Kidney allocation is currently geographical, relying on individual or regional center policies.
- This study evaluates short-term outcomes of paired kidneys from DCD donors under the existing allocation system.
Purpose of the Study:
- To assess the short-term outcomes of paired kidney transplants from DCD donors in London.
- To compare cold ischemia time (CIT) and delayed graft function (DGF) between first and second transplanted kidneys.
Main Methods:
- Retrospective analysis of 129 paired renal transplants from DCD donors between 2002 and 2010.
- Comparison of cold ischemia time (CIT), recipient risk factors, delayed graft function (DGF), and creatinine levels at 3 and 12 months.
- Analysis of transplants performed within the same center versus different centers.
Main Results:
- A significant increase in CIT was observed for the second kidney in both same-center (15.5 vs. 20.5 hrs) and different-center (15.8 vs. 25.2 hrs) transplants.
- Delayed graft function (DGF) rates were significantly higher for the second transplanted kidney (p=0.05).
Conclusions:
- Sequential transplantation of paired kidneys from DCD donors increases cold ischemia time and the risk of delayed graft function for the second kidney.
- Avoid sequential transplantation from DCD donors by ensuring resources for simultaneous procedures or allocating kidneys to separate centers.
Background:
There is no national policy for allocation of kidneys from Donation after circulatory death (DCD) donors in the UK. Allocation is geographical and based on individual/regional centre policies. We have evaluated the short term outcomes of paired kidneys from DCD donors subject to this allocation policy.
Methods:
Retrospective analysis of paired renal transplants from DCD's from 2002 to 2010 in London. Cold ischemia time (CIT), recipient risk factors, delayed graft function (DGF), 3 and 12 month creatinine) were compared.
Results:
Complete data was available on 129 paired kidneys.115 pairs were transplanted in the same centre and 14 pairs transplanted in different centres. There was a significant increase in CIT in kidneys transplanted second when both kidneys were accepted by the same centre (15.5 ± 4.1 vs 20.5 ± 5.8 hrs p<0.0001 and at different centres (15.8 ± 5.3 vs. 25.2 ± 5.5 hrs p=0.0008). DGF rates were increased in the second implant following sequential transplantation (p=0.05).
Conclusions:
Paired study sequential transplantation of kidneys from DCD donors results in a significant increase in CIT for the second kidney, with an increased risk of DGF. Sequential transplantation from a DCD donor should be avoided either by the availability of resources to undertake simultaneous procedures or the allocation of kidneys to 2 separate centres.
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