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Pursuing expanded criteria donors as candidates for kidney donation after circulatory death
Ginger T DeLario1, Jim Quetschenbach1, Donna Croezen1
1Carolina Donor Services, Durham, North Carolina.
Abstract:
Of the 119 310 people on the national transplant waiting list, 97 280 people are waiting for kidneys. There simply are not enough organs to meet the demand. Recognizing that 64% of the people waiting for kidney transplants are at least 50 years old, this organ procurement organization embarked on a study to evaluate the potential of increasing the number of viable kidneys available for transplant by pursuing expanded criteria donors as donation after circulatory death (ECD/DCD) candidates. Pursuing ECD/DCD donors resulted in 24 additional donors (50-67 years old), 48 kidneys recovered, 30 kidneys transplanted into 26 recipients (44-74 years old), 7 kidneys placed for research, and 11 kidneys discarded, yielding an overall 62% transplant rate, 15% research rate, and 23% discard rate. The overall discard rate including all donors in all classifications during the study period was 13.1% (122 discards from 928 kidneys) compared with 12.6% (111 discards from 880 kidneys) when the study set was excluded. Although ECD/DCD donors still had the highest discard rates of all the groups, the 0.5% increase in the overall discard rate due to pursuing ECD/DCD kidneys was considered insignificant when compared with the benefit of the 30 additional kidneys transplanted. Including potential ECD/DCD patients in the donor pool increases the number of viable kidneys available for transplant without significantly increasing the overall kidney discard rates.
Insights
Expanding organ donation criteria to include donation after circulatory death (DCD) donors increases viable kidney transplants. This approach adds kidneys for transplant without significantly raising overall discard rates, benefiting patients on the national transplant waiting list.
Area of Science:
- Nephrology
- Transplantation Medicine
- Organ Procurement
Background:
- The national kidney transplant waiting list exceeds 97,000 individuals, with a significant portion (64%) aged 50 or older.
- A critical shortage of available organs exists, limiting transplantation opportunities.
- Expanded criteria donors, specifically donation after circulatory death (DCD) candidates, present a potential source to increase organ supply.
Purpose of the Study:
- To evaluate the feasibility and impact of including donation after circulatory death (ECD/DCD) candidates in the donor pool.
- To determine if pursuing ECD/DCD donors can increase the number of viable kidneys for transplantation.
- To assess the effect of utilizing ECD/DCD kidneys on overall kidney discard rates.
Main Methods:
- An organ procurement organization studied the outcomes of pursuing expanded criteria donors as ECD/DCD candidates.
- Data collected included the number of additional donors, recovered kidneys, transplanted kidneys, kidneys for research, and discarded kidneys.
- Discard rates were compared between the study group (ECD/DCD) and the overall donor population.
Main Results:
- Pursuing ECD/DCD donors yielded 24 additional donors (ages 50-67) and 48 recovered kidneys.
- Thirty kidneys were transplanted into 26 recipients (ages 44-74), with 7 allocated for research and 11 discarded.
- The ECD/DCD group had a 23% discard rate, contributing to a 0.5% increase in the overall discard rate (13.1% vs. 12.6%), which was deemed insignificant.
Conclusions:
- Including potential ECD/DCD patients in the donor pool significantly increases the availability of viable kidneys for transplantation.
- This strategy enhances the organ supply without a substantial rise in overall kidney discard rates.
- Utilizing ECD/DCD donors is a viable approach to address the organ shortage for kidney transplantation.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure