Costs associated with expanding donor criteria: A collaborative statewide prospective study

Jacobbi, Louise M.; McBride, Virginia; Etheredge, Edward E.; McDonald, J.C.; Feduska, Nicholas J.; Frey, Daniel; Boudreaux, J Philip; Meter, Clifford Van; McMillan, R. W.; Tesi, Raymond J.

doi:10.1016/s0041-1345(96)00672-0

Cited by 7 publications

(2 citation statements)

References 6 publications

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“…Some centres will not accept kidneys from donors with a history of hypertension, diabetes mellitus [6,11] or risk factors for AS [6]. In other reports, hypertension and diabetes are reported as being individual risk factors [6,12,13] for a non‐ideal donor to be considered along with other donor factors.…”

Section: Discussionmentioning

confidence: 99%

Factors in older cadaveric organ donors impacting on renal allograft outcome

Verran

DeLeon

Chui

et al. 2001

Clinical Transplantation

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Transplantation of renal allografts (RA) from older donors has become more common, despite conflicting data on outcome between reports from large series versus individual centres. Factors other than donor age per se may contribute to RA outcome. The outcome of RA procured from 114 older donors over 55 yr of age in NSW, between 1990 and 1997, was analysed. Corresponding donor factors, including demographics, medical history, inotrope use, major hypotension and findings at procurement, were also analysed. Of the potential RA, 8% were discarded and the remainder transplanted. Factors significantly associated with renal discard were pre-transplantation donation biopsy abnormality (p < 0.001) and a history of cardiovascular (CV) disease in the donor (p < 0.02). Donor aortorenal atherosclerosis (AS; p < 0.09) and a donor age of 65 yr or older (p < 0.08) were common in the discard group. The never function rate was 7.6% and was associated with a history of a discarded partner kidney (p < 0.05). The delayed graft function rate was 33% and was associated with a history of donor CV disease. At a median follow up of 5 yr, the death censored allograft failure rate was 24%. Allograft failure was associated with a history of donor hypertension (p < 0.05). Donor AS (p < 0.7) tended to have been more common in the allograft failure group. A number of cadaveric organ donor factors documented at procurement may be associated with inferior outcome of RA. These include biopsy abnormality, history of donor CV disease and history of donor hypertension. A donor age of 65 yr or older or significant visible aortorenal AS may also be factors. This retrospective review of kidneys procured from 114 older cadaveric organ donors identifies factors apart from donor age, which may have a negative impact on both allograft utilisation and outcome. Theses factors include renal biopsy abnormality, history of donor CV disease, discard of a partner kidney and donor hypertension. Visible AS in the donor aorta documented at renal procurement may also be a factor.

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Section: Discussionmentioning

confidence: 99%

Factors in older cadaveric organ donors impacting on renal allograft outcome

Verran

DeLeon

Chui

et al. 2001

Clinical Transplantation

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“…In the last decade Organ Procurement Organizations (OPOs) and transplant centers began evaluating and expanding their acceptability criteria of organs from cadaver donors. The most common reluctance noted in establishing this practice was organ evaluation and cost [71]. The ability to evaluate transplantable organs from expanded criteria - defined by the advanced age of the donor or additional donor risk factors such as hypertension and diabetes - and asystolic donors by machine in-vitro perfusion may significantly increase the number of organs available for transplantation and is one of the potential benefits currently being explored [8].…”

Section: Why Perfuse? Continuous Perfusion Versus Static Cold Storagementioning

confidence: 99%

Current state of hypothermic machine perfusion preservation of organs: The clinical perspective

2010

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This review focuses on the application of hypothermic perfusion technology as a topic of current interest with the potential to have a salutary impact on the mounting clinical challenges to improve the quantity and quality of donor organs and the outcome of transplantation. The ex vivo perfusion of donor organs on a machine prior to transplant, as opposed to static cold storage on ice, is not a new idea but is being re-visited because of the prospects of making available more and better organs for transplantation. The rationale for pursuing perfusion technology will be discussed in relation to emerging data on clinical outcomes and economic benefits for kidney transplantation. Reference will also be made to on-going research using other organs with special emphasis on the pancreas for both segmental pancreas and isolated islet transplantation. Anticipated and emerging benefits of hypothermic machine perfusion of organs are: i) maintaining the patency of the vascular bed, ii) providing nutrients and low demand oxygen to support reduced energy demands, iii) removal of metabolic by-products and toxins, iv) provision of access for administration of cytoprotective agents and/or immunomodulatory drugs, v) increase of available assays for organ viability assessment and tissue matching, vi) facilitation of a change from emergency to elective scheduled surgery with reduced costs and improved outcomes, vii) improved clinical outcomes as demonstrated by reduced PNF and DGF parameters, viii) improved stabilization or rescue of ECD kidneys or organs from NHBD that increase the size of the donor pool, ix) significant economic benefit for the transplant centers and reduced health care costs, and x) provision of a technology for ex vivo use of non-transplanted human organs for pharmaceutical development research.

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