Early results of a controlled non-heart-beating kidney donor programme

Abstract

Structured implementation resulted in a successful CNHBD programme providing 61 successful renal transplants from 35 donors in 3 years-contributing to approximately 50% of the total number of cadaveric renal transplants during the period. At 12 months, CNHBD kidney graft function was equivalent to HBD organs.

Kidney donation after cardiac death

“…As a result, outcomes of such transplantation were poor and it was not surprising that with the establishment of brain stem legislation, DCD programmes were abandoned. Things have improved since those early days and due to a continuing lack of organs, many transplant centres in the developed world have returned to DCD [11,12] . The first kidney transplant in the world from DBD was performed in Belgium in June 1963.…”

“…Since its implementation four and a half years ago, DCD has accounted for 10.9% of deceased donor activity in Ontario, Canada [18] . The majority of DCD kidneys are from controlled donors meaning that the number of organs can be further increased by utilising uncontrolled donors [3,4,12,[19][20][21][22][23][24][25][26][27][28][29][30] although the associated workload is considerably more and the yield rate poorer. Reports from some centres show that DCD from deaths outside the hospital may be a good source of donor kidneys and may provide a way to successfully increase the donor pool for organ transplantation [31] .…”

“…Following this, a strong majority of participants supported proceeding with DCD programs in Canada with very successful results. Structured implementation in the author's centre resulted in a successful controlled DCD programme providing 61 successful renal transplants from 35 donors in 3 years-contributing to approximately 50% of the total number of cadaveric renal transplants during the period [12] . Marks et al [8] discussed the implementation and effect of the federally initiated Organ Donation Breakthrough Collaborative and reviewed living and deceased donation data, from 1995 to 2004.…”

“…The viability of a DCD program can be determined by conducting a potential donor audit [12,51,52] . Such an audit should take into consideration medical suitability, logistic availability, family refusal to consent, and the likelihood of the donation to proceed to successful organ recovery as well as the risk of technical failures.…”

“…Fifty-six kidneys were retrieved and 53 successfully transplanted giving a discard rate of 5.7% (3/53) [21] . The series from the author's centre reported a conversion rate of 44% and discard rate of 12.9% (9/70) [12] whereas 77% (67/87) were converted in Ontario Canada [18] . The series from Madrid exhibited a high discard rate (34%) despite the use of cardiopulmonary bypass.…”