Non-heart beating organ donation: overview and future perspectives

Abstract

Summary New indications for organ transplantation combined with a stagnating number of available donor grafts have severely lengthened the waiting list for almost all types of transplantations. This has led to a renewed interest in non‐heart beating (NHB) donation, as a possible solution to bridge the gap between supply and demand. In this review, we present an overview of current NHB donation practice, outcome, existing problems and future perspectives. We focus on possible improvements in donor management, recipient care and new methods of organ preservation that may be better suited for these marginal organs. Successful institution of NHB protocols depends on adapting current transplantation practice at all levels, which is one of the greatest challenges for researchers and professionals in this interesting re‐emerging field.

The Prognostic Value of Renal Resistance During Hypothermic Machine Perfusion of Deceased Donor Kidneys

“…Hypothermic machine perfusion (HMP) preserves kidney grafts by continuous or pulsatile administration of a recirculating cold (1)(2)(3)(4)(5)(6)(7)(8)(9)(10) • C) preservation solution. The Machine Preservation Trial (MP Trial) recently showed that HMP decreases the incidence of primary nonfunction (PNF) and delayed graft function (DGF), and increases 1-year graft survival compared to standard static cold storage (1).…”

“…As these kidneys have a higher incidence of PNF and DGF compared with standard criteria donor (SCD) kidneys (5,6), the need for specific and sensitive surrogates of their quality is becoming even more critical. The absence of prospective analyses of the association between perfusion parameters and kidney transplant outcome, and the increasingly urgent need for valid predictors of graft outcome led us to analyze the association between prospectively collected RR values and kidney graft outcome in a substudy of the MP Trial.…”

Post–Cardiac Arrest Syndrome

“…A number of studies have reported no difference in transplant outcomes whether the organs were obtained from appropriately selected post-cardiac arrest patients or from other brain-dead donors. [23][24][25] Non-heart-beating organ donation has also been described after failed resuscitation attempts after in-and out-of-hospital cardiac arrest, 26,27 but these have generally been cases in which sustained ROSC was never achieved. The proportion of cardiac arrest patients dying in the critical care unit and who might be suitable non-heartbeating donors has not been documented.…”

Marginal donor grafts in heart transplantation: lessons learned from 25 years of experience

“…In 1995, at the first international workshop on NHBD in Maastricht, consensus was reached about donor management protocols, and four different categories of NHB donors were defined as the so-called 'Maastricht classification' [148]. Ever since, the practice of NHBD has increasingly become a part of transplant programs worldwide; within Eurotransplant, 6% of all kidney donors in the year 2005 were NHBD [149]. Although there are very few reports indicating that NHBD programs might have only little impact on potential thoracic organ recovery [150], even in thoracic organ transplantation, use of NHBD has become an option and is clinically used in pulmonary transplantation with increasing tendency [151,152].…”