Preservation of kidneys from controlled donors after cardiac death

Wind, Jentina; Snoeijs, Maarten G.; Vliet, J. Adam van der; Winkens, Björn; Christiaans, Maarten H. L.; Hoitsma, Andries J.; Heurn, L. W. Ernest van

doi:10.1002/bjs.7543

Cited by 18 publications

(8 citation statements)

References 17 publications

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“…The most commonly used preservation method for controlled DCD donation is rapid laparotomy with cannulation of the abdominal aorta [16]. After death in the ICU, the deceased is taken to the operating room.…”

Section: Resultsmentioning

confidence: 99%

Variability in protocols on donation after circulatory death in Europe

et al. 2013

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IntroductionOrgan donation after circulatory death (DCD) has become an accepted strategy to reduce the shortage of organs for transplantation in many European countries. The use and number of DCD donors varies between countries. The purpose of this study was to evaluate the available protocols for DCD in Europe.MethodsWe contacted national transplant societies and responsible transplant co-ordinators in the countries that perform DCD to obtain DCD protocols. We compared information on the protocols and additional data including: inclusion and exclusion criteria for donation, legislation, determination of death and preservation methods.ResultsIn ten European countries DCD is performed, eight of which describe the methods in protocols. There are large differences in used DCD categories, legislation and the way death is determined. Protocols differ in the detail in which DCD procedures are described and the way methods are supported by additional consensus statements and ethical frameworks.ConclusionsAlthough DCD is an established strategy to enlarge the donor pool and to contribute to the reduction of the waiting list for transplantation, its potential has not been fully utilized yet. To further promote DCD transplantation, it is important to share expertise and obtain consensus, so that this can be translated into more uniform and solid protocols supported by the competent authorities, transplant and intensive care professionals, which may eventually result in a further promotion of DCD transplantation in Europe.

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Section: Resultsmentioning

confidence: 99%

Variability in protocols on donation after circulatory death in Europe

et al. 2013

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“…To assess if the high percentage of PNF could be reduced, room for improvement of donor, preservation, and recipient characteristics that potentially affect the outcome after transplantation in our previously treated group of transplants was evaluated. Potential risk factors for poor outcome that were analyzed included (i) donor age; (ii) DCD category; (iii) warm ischemia time, including duration and the method of in situ preservation (ISP); and (iv) duration of cold ischemia time (CIT) .…”

Section: Resultsmentioning

confidence: 99%

“…The association was stronger than for warm ischemia time (including the no‐touch period and ISP insertion time) . Moreover, direct cannulation of the aorta was superior to ISP for controlled donors . Duration of cold ischemia was tried to be kept to a minimum.…”

Section: Resultsmentioning

confidence: 99%

Improvements in kidney transplantation from donors after cardiac death

Hoogland

Snoeijs

Habets

et al. 2013

Clinical Transplantation

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To reduce the growing waiting list for kidney transplantation, we explored the limits of kidney transplantation from donors after cardiac death by liberally accepting marginal donor kidneys for transplantation. As the percentage of primary non-function (PNF) increased, we evaluated our transplantation program and implemented changes to reduce the high percentage of PNF in 2005, followed by a second evaluation over the period 2006-2009. Recipients of a kidney from a donor after cardiac death between 1998 and 2005 were analyzed, with PNF as outcome measure. During the period 2002-2005, the percentage of PNF increased and crossed the upper control limits of 12% which was considered as unacceptably high. After implementation of changes, this percentage was reduced to 5%, without changing the number of kidney transplantations from donors after cardiac death. Continuous monitoring of the quality of care is essential as the boundaries of organ donation and transplantation are sought. Meticulous donor, preservation, and recipient management make extension of the donor potential possible, with good results for the individual recipient. Liberal use of kidneys from donors after cardiac death may contribute to a reduction in the waiting list for kidney transplantation and dialysis associated mortality.

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“…*A logistic regression model was used to determine the odds ratio for PNF, and a Cox proportional hazards model was used to determine the hazards ratio for death censored graft failure of primarily functioning kidneys. Direct cannulation of the aorta is the method of choice to preserve kidneys of DCD donors [33]. In the Netherlands, minor invasive procedures are allowed to preserve the organs of potential donors before consent of the relatives and if a patient is not registered with objection in the national donor registry.…”

Section: Discussionmentioning

confidence: 99%

Kidneys from uncontrolled donors after cardiac death: which kidneys do worse?

et al. 2013

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SummaryKidneys from uncontrolled donors after cardiac death (DCD) expand the donor pool, but are associated with more primary nonfunction (PNF) and delayed graft function (DGF) compared with more conventional donor kidneys. It remains unclear, which factors influence outcome of uncontrolled donation. Therefore, we studied which donor, graft, and recipient characteristics are associated with PNF in a large cohort study. The association between different characteristics and short-term graft function was analyzed for kidneys procured in the Maastricht region from 1 January 1981 to 1 July 2009. Patients were followed until 7 January 2010. A total of 135 uncontrolled donor kidneys were included in this study. The incidence of PNF and DGF was 22% and 61%, respectively. Increasing donor age is an independent risk factor for graft failure in a univariate analysis (OR 1.035, 95% CI 1.004-1.068, P = 0.028). Donor age remains strongly associated with PNF in a multivariate analysis (OR 1.064, 95% CI 1.013-1.118, P = 0.014). However, the predictive value of donor age alone is poor (AURC 0.640, 95% CI 0.553-0.721). Increasing donor age of uncontrolled DCD donors is a major risk factor for PNF. Other clinically relevant variables were not associated with PNF. Donor age is strongly associated with PNF and remains an important parameter in donor selection.

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Preservation of kidneys from controlled donors after cardiac death

Abstract: In this retrospective study, direct aortic cannulation appeared to be a better method to preserve controlled DCD kidneys.

Cited by 18 publications

References 17 publications

Variability in protocols on donation after circulatory death in Europe

Variability in protocols on donation after circulatory death in Europe

Improvements in kidney transplantation from donors after cardiac death

Kidneys from uncontrolled donors after cardiac death: which kidneys do worse?

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