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In situ preservation of kidneys from non-heart-beating donors--a proposal for a standardized protocol
M H Booster1, R M Wijnen, J P Vroemen
1Department of Surgery, University Hospital, Maastricht, The Netherlands.
Insights
Non-heart-beating (NHB) donor kidneys can be successfully transplanted using an emergency in situ perfusion technique. This method increases kidney availability for transplantation without compromising long-term graft survival.
Area of Science:
- Nephrology
- Transplantation Surgery
- Organ Procurement
Background:
- Increasing success in renal transplantation drives demand for donor organs.
- Procurement from heart-beating (HB) donors is insufficient to meet demand.
- Non-heart-beating (NHB) donors represent an underutilized source of renal grafts.
Purpose of the Study:
- To present a protocol for emergency in situ perfusion to salvage NHB donor kidneys.
- To evaluate the feasibility and outcomes of using NHB donor kidneys preserved with this technique.
Main Methods:
- Development and implementation of an emergency in situ perfusion protocol.
- Prompt action and cooperation of emergency personnel are crucial.
- Application of the protocol in a hospital setting.
Main Results:
- The in situ perfusion technique effectively limits warm ischemic damage in NHB kidneys.
- Implementation at University Hospital of Maastricht increased kidney availability by 20%.
- NHB donor kidneys exhibited higher delayed graft function rates than HB kidneys but similar long-term survival.
Conclusions:
- Emergency in situ perfusion is a viable method to increase the pool of transplantable NHB donor kidneys.
- This technique can significantly enhance organ availability for renal transplantation.
- Long-term graft survival is comparable between NHB and HB donor kidneys when preserved appropriately.
Abstract:
The growing success in renal transplantation has resulted in an increase in the need for donor organs. Procurement of kidneys from heart-beating (HB) donors is unlikely ever to meet this demand. Non-heart-beating (NHB) donors offer a yet untapped source of renal grafts. Cadaver kidneys from patients who have sustained cardiac standstill are often considered unsuitable for transplantation due to prolonged warm ischemia time. Using an emergency in situ perfusion technique it is possible to limit warm ischemic damage and to salvage these kidneys for transplantation. The procedure requires prompt action and cooperation of emergency service personnel. This report presents a protocol for the emergency in situ preservation procedure that can be practiced in most hospitals. At the University Hospital of Maastricht, The Netherlands, implementation of this procedure resulted in 20% more kidneys available for transplantation. Although NHB donor kidneys showed a higher rate of delayed function compared with a matched HB donor kidney population, there was no significant difference in long-term graft survival between the two groups.