Non-heartbeating donation of kidneys for transplantation

Kootstra, G.; Heurn, Ernest van

doi:10.1038/ncpneph0426

Cited by 58 publications

(46 citation statements)

References 61 publications

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“…The DCD donor was previously referred to as non-heart-beating donor. The DCD categories encompass four subgroups, depending on the circumstances and manner in which cardiac standstill occurred (Maastricht classification), but only two subtypes of DCD are in common usage (controlled DCD and uncontrolled DCD), which are defined next (12).…”

Section: Donation After Cardiac Deathmentioning

confidence: 99%

The Alphabet Soup of Kidney Transplantation

Rao

Ojo

2009

Clinical Journal of the American Society of Nephrology

171

109

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There is significant variability in the quality of deceased-donor kidneys that are used for transplantation. The quality of the donor kidney has a direct effect on important clinical outcomes such as acute rejection, delayed graft function, and patient and allograft survival. Expanded-criteria donors (ECDs) refer to older kidney donors (>60 yr) or donors who are aged 50 to 59 yr and have two of the following three features: Hypertension, terminal serum creatinine >1.5 mg/dl, or death from cerebrovascular accident. By definition, ECD kidneys have a 70% greater likelihood of failure compared with one from a 35-yr-old male donor who died from a motor vehicle accident. Donation after cardiac death (DCD) is a small but rapidly growing fraction of donors. An ECD kidney transplant recipient has a projected average added-life-years of 5.1 yr compared with 10 yr for a kidney recipient from a standard-criteria donor. Kidney transplantation from DCD seems to have similar allograft and patient survival compared with kidney from donation after brain death; however DCD transplantation has a 42 to 51% risk for delayed graft function (need for at least one dialysis treatment during the first week after transplantation) compared with 24% in an standard-criteria donor kidney transplant. Familiarity with the comprehensive allocation rules governing different categories of deceased-donor kidneys by the nephrologists and dialysis team providers is essential to maximizing patient autonomy and to improve the outcomes of kidney transplantation.Clin T ransplantation with organs from deceased donors (DDs) account for Ͼ50% of kidney transplantation in the United States. More than 90% of patients who had ESRD and underwent DD kidney transplantation would have experienced prolonged duration (average of 3 to 5 yr) of maintenance dialysis therapy before receiving a kidney transplant (1). During this pretransplantation dialysis spell, patients develop a strong relationship with their providing nephrologist and dialysis team members. Through this patient-provider relationship, the nephrologist gains a comprehensive picture of the patient's medical condition and is knowledgeable about the evolution of comorbidities, health-related quality of life, functional status, beliefs, and value systems. This relationship is crucial to making major therapeutic decisions, including the acceptance of a DD organ for transplantation; however, the providing nephrologist is typically absent from the organ allocation and offer acceptance process, and the patient with ESRD is provided circumscribed information laden with medical jargon about the quality of the DD organ under offer. In the rapid-fire tempo of activities surrounding the identification and matching of an organ to a recipient (computerized match run) and in the excitement of the moment (after seemingly interminable waiting on the kidney transplant waiting list), most potential recipients accept any organ under offer. Commonly, the transplant team member who makes the organ offer does not have a long-s...

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Section: Donation After Cardiac Deathmentioning

confidence: 99%

The Alphabet Soup of Kidney Transplantation

Rao

Ojo

2009

Clinical Journal of the American Society of Nephrology

171

109

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“…However, the persistent shortage of donor kidneys remains a universal problem due to the inclusion of older, marginal and non-heart-beating donor kidney sources in the donor pool at present (10). These kidneys are more susceptible to ischemic damage, leading to delayed graft function or primary non-function, as well as worse graft function and survival.…”

Section: Discussionmentioning

confidence: 99%

Protective effect of tanshinone IIA on rat kidneys during hypothermic preservation

Zhang

et al. 2011

Mol Med Report

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Abstract. Renal preservation is a universal problem since ischemia/reperfusion (I/R) injury remains an unresolved issue during the procedure of renal transplantation. Tanshinone IIA, one of the effective components of the traditional Chinese medicine Danshen, was reported to exhibit a variety of biochemical activities, including protection against I/R injury. Therefore, identifying the specific molecular pathway mediating tanshinone IIA protection of renal preservation would be of great value to the patients concerned. In this study, rats were divided into two groups and the kidneys were isolated and preserved in two solutions separately, one with Celsior solution and the other with tanshinone IIA additionally added to the Celsior solution. The superoxide dismutase (SOD) activity and the quantity of malonaldehyde (MDA) were measured, the expression of CHOP and caspase-12 were assessed by immunohistochemistry staining, and real-time quantitative reverse transcription-polymerase chain reaction analysis was performed after 0, 24 and 48 h of preservation. A significant increase in the activities of SOD and a decrease in the quantity of MDA were observed in the kidneys preserved with tanshinone IIA at 24 and 48 h (P<0.01). The expression of CHOP and caspase-12 was lower in the kidneys preserved with tanshinone IIA at 24 and 48 h than that in the kidneys preserved with Celsior solution alone (P<0.05). The results suggest that the supplementation of tanshinone IIA in standard Celsior solution may significantly improve long-term kidney preservation. Attenuating oxidative stress injury and decreasing endoplasmic reticulum (ER) stress-mediated apoptosis may play a role in the protection of kidney hypothermic preservation.

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“…To shorten the warm ischemia time is important to protect graft functions. Although there are some written rules, different conditions may emerge in different circumstances (5,9,10). Some institutions have composed protocols for several surgical techniques and perfusion solutions for ex-vivo and in-vivo cold perfusion methods (5,9,11).…”

Section: Discussionmentioning

confidence: 99%

Urgent Organ Retrieval from Non-Heart-Beating Donor with Declared Brain Death: Harvest at Arrest

Yıldız¹,

Koca²,

Sabuncuoğlu³

2017

chr

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RezumatScop: Din cauza numărului insuficient de donatori disponibili pentru a acoperi nevoia de transplanturi de organe, noi cercetări sunt în desfăşurare. În contextul acesta, cazurile de stop cardiac şi moarte cerebrală au fost evaluate ca donatori probabili în cursul ultimilor ani. Scopul acestui studiu este de a discuta tehnicile salutare de prelevare de organe cu distrugere minimă a ţesutului şi rapiditate maximă de efectuare, în condiţiile asigurate de centrul nostru, precum şi experienţa proprie în acest domeniu. Materiale şi metode: Un număr total de 4 din 13 pacienţi aflaţi în moarte cerebrală care au prezentat stop cardiac în aşteptarea rezultatelor de laborator în cadrul centrului nostru în perioada 2015-2016 au fost conduşi către sala de operaţie de urgenţă sub masaj cardiac şi s-a efectuat prelevare de organe în regim de urgenţă. Datele clinice ale acestui grup specific au fost analizate. Rezultate: În perioada 2015-2016 au existat 13 cazuri de prelevare de organe de la pacienţi aflaţi în moarte cerebrală. Din aceste 13 cazuri, 9 au fost supuse laparotomiei şi canulării de urgenţă, iar organele au fost prelevate după perfuzia cu soluţie rece in situ, fără alte complicaţii. În schimb, în 4 cazuri care au prezentat stop cardiac la care s-a efectuat perfuzie cu soluţii reci ex-vivo din lipsa de mijloace în sala de operaţie, afectarea vasculară şi parenchimală au apărut la nivelul a două organe hepatice şi a 2 rinichi. Utilizând această tehnică au fost prelevate şi transplantate 4 ficati şi 8 rinichi. Concluzii: Laparotomia de urgenţă, canularea şi perfuzia cu soluţii saline reci in situ reprezintă abordarea ideală pentru un timp de

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Non-heartbeating donation of kidneys for transplantation

Cited by 58 publications

References 61 publications

The Alphabet Soup of Kidney Transplantation

The Alphabet Soup of Kidney Transplantation

Protective effect of tanshinone IIA on rat kidneys during hypothermic preservation

Urgent Organ Retrieval from Non-Heart-Beating Donor with Declared Brain Death: Harvest at Arrest

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