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Updated: May 5, 2026
Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation
Published on: July 15, 2015
How do we increase deceased donor kidney utilization and reduce discard?
Venkatesh K Ariyamuthu1, Abd A Qannus, Bekir Tanriover
1Division of Nephrology, University of Arizona, COM, Tucson, Arizona, USA.
Purpose Of Review:
This review aims to address the critical issue of expanding deceased donor kidney pool and reducing the discard rates of viable kidneys in the United States. It highlights advances in organ preservation techniques and explores strategies for expanding the donor pool by leveraging suboptimal and high-risk nonuse kidneys, including those affected by acute kidney injury (AKI), hepatitis C virus (HCV), and hepatitis B virus (HBV).
Recent Findings:
Innovations in organ preservation, including hypothermic and normothermic machine perfusion, have demonstrated efficacy in improving outcomes for marginal and extended-criteria kidneys. The integration of normothermic regional perfusion (NRP) for donation after cardiac death (DCD) donors has enhanced organ utilization and graft viability. Additionally, research confirms that kidneys from AKI and HCV-positive donors, when managed with appropriate protocols, yield comparable long-term outcomes to standard transplants. Emerging data on HBV-positive donor kidneys further underscore their potential to safely expand transplant access with targeted antiviral prophylaxis.
Summary:
Optimizing deceased donor kidney utilization requires a multi-faceted approach, including advancements in preservation technologies, evidence-based decision-making for high-risk organs, and policy innovations. Leveraging these strategies can help address the growing organ shortage, enhance transplant outcomes, and ensure broader access to life-saving kidney transplants.
Insights
Expanding the deceased donor kidney pool involves using marginal organs from donors with acute kidney injury (AKI), hepatitis C virus (HCV), and hepatitis B virus (HBV). Advanced preservation techniques improve outcomes and increase kidney transplant access.
Area of Science:
- Nephrology
- Transplantation
- Organ Preservation
Background:
- The United States faces a critical shortage of deceased donor kidneys, leading to high discard rates of viable organs.
- Suboptimal and high-risk kidneys, including those from donors with acute kidney injury (AKI), hepatitis C virus (HCV), and hepatitis B virus (HBV), are often underutilized.
Purpose of the Study:
- To review strategies for expanding the deceased donor kidney pool.
- To reduce the discard rates of viable kidneys in the US.
- To explore the use of marginal and high-risk donor kidneys.
Main Methods:
- Review of advances in organ preservation techniques, including hypothermic and normothermic machine perfusion.
- Analysis of normothermic regional perfusion (NRP) for donation after cardiac death (DCD) donors.
- Examination of outcomes for kidneys from donors with AKI, HCV, and HBV.
Main Results:
- Hypothermic and normothermic machine perfusion improve outcomes for marginal and extended-criteria kidneys.
- NRP enhances organ utilization and graft viability in DCD donors.
- Kidneys from AKI and HCV-positive donors show comparable long-term outcomes to standard transplants with appropriate protocols.
- HBV-positive donor kidneys offer potential for expanded transplant access with antiviral prophylaxis.
Conclusions:
- Optimizing deceased donor kidney utilization requires a multi-faceted approach.
- Advancements in preservation technologies and evidence-based decision-making for high-risk organs are crucial.
- Policy innovations are needed to address organ shortage and enhance transplant access.
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