Kidney transplant outcome of expanded criteria donors after circulatory death

Monteoliva, Paloma Barreda; Redondo‐Pachón, Dolores; García, Eduardo Miñambres; Calabia, Emilio Rodrigo

doi:10.1016/j.nefroe.2021.01.005

Cited by 6 publications

(4 citation statements)

References 51 publications

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“…In recent years, deceased donor strategies have had greater international success in increasing the pool of donors, particularly using older and expanded criteria donors. Some countries have also increased their pool of deceased donors based on post-cardiac arrest diagnosis, which is limited to countries with better health and logistics programs 29 .…”

Section: Discussionmentioning

confidence: 99%

Paired kidney donation: are we going beyond reasonable limits in living-donor transplantation?

et al. 2022

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The growing demand for transplant kidneys requires strategies to increase organ supply and avoid long waiting periods on the list. The increase in the number of transplants from living donors involves the growth in the use of unrelated donors and paired kidney donation. Most of these transplants are performed in the USA, where they already represent, respectively, 34% and 16% of total transplants from living donors. In Latin America, and especially in Brazil, there is no collective enthusiasm for these modalities, either at the request of transplanters or that of the community, with the region's priority being to increase transplants from deceased donors, which growth can be up to three-fold. Concerning transplants from matched donors, the possible conflicting results between donors can generate public challenges and they risk compromise the concepts of equal opportunities for transplant candidates, with the possibility of generating resistance to organ donation, especially in regions with socioeconomic limitations and disparities in access to qualified health care and education. This donation model involves challenging ethical and logistical issues, which are subject to questionings, starting with an act of exchange between two pairs until reaching embarrassing proposals, which can compromise the altruistic character of organ donation, and thus not be universally incorporated.

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Section: Discussionmentioning

confidence: 99%

Paired kidney donation: are we going beyond reasonable limits in living-donor transplantation?

et al. 2022

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“…Transplanting kidneys from DCD donors over the age of 60 confers a large survival advantage (adjusted hazard rate: 0.52, P < 0.01) compared with declining an older DCD offer and waiting for a more ideal kidney [59]. Minimizing CIT and using machine perfusion may be keys to successful utilization of ECD/DCD kidneys [60], particularly to reduce risk of delayed graft function [51].…”

Section: Donation After Circulatory Deathmentioning

confidence: 99%

“…Minimizing CIT and using machine perfusion may be keys to successful utilization of ECD/DCD kidneys [60], particularly to reduce risk of delayed graft function [51].…”

Section: Donation After Circulatory Death Kidneysmentioning

confidence: 99%

Beyond donation to organ utilization in the USA

Stewart

Lonze

2023

Current Opinion in Organ Transplantation

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Purpose of reviewThe deceased donor organ pool has broadened beyond young, otherwise healthy head trauma victims. But an abundance of donated organs only benefits patients if they are accepted, expeditiously transported and actually transplanted. This review focuses on postdonation challenges and opportunities to increase the number of transplants through improved organ utilization. Recent findingsWe build upon recently proposed changes in terminology for measuring organ utilization. Among organs recovered for transplant, the nonuse rate (NUR REC ) has risen above 25% for kidneys and pancreata. Among donors, the nonuse rate (NUR DON ) has risen to 40% for livers and exceeds 70% for thoracic organs. Programme-level variation in offer acceptance rates vastly exceeds variation in the traditional, 1-year survival benchmark. Key opportunities to boost utilization include donation after circulatory death and hepatitis C virus (HCV)þ organs; acute kidney injury and suboptimal biopsy kidneys; older and steatotic livers.

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“…Kidneys from older donors are less likely to recover from significant ischaemic injury 3 . Furthermore, DCD kidneys incur additional warm ischaemic injury which results in a higher likelihood of DGF or the possibility of irreversible damage resulting in primary non-function 3,4,9 . Preserving organs at a normothermic temperature as an alternative or adjunct to hypothermic preservation may help to improve graft outcomes and increase organ utilisation 10 .…”

Section: Introductionmentioning

confidence: 99%