Response to organ shortage: kidney retrieval programme using non-heart beating donors

Varty, K.; Veitch, P. S.; Morgan, James; Kehinde, E.O.; Donnelly, P. K.; Bell, P. R. F.

doi:10.1136/bmj.308.6928.575

Cited by 53 publications

(10 citation statements)

References 4 publications

(3 reference statements)

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“…EDITOR, - The results of the programme for obtaining organs from non- heart beating organ donors reported by K Varty and colleagues1 are compatible with those from other centres world-wide*RF 2-4* and show that such donors are an important potential source of kidneys for transplantation. We have been planning a similar programme but have hesitated because of uncertainty about the public response and the quality of the organs.…”

supporting

confidence: 57%

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Non-heart beating organ doners for transplantation

Ferguson

Moore

Griffin

et al. 1994

BMJ

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supporting

confidence: 57%

“…We think it unfortunate that the paper by Varty and colleagues1 and that by A O Phillips and colleagues5 were published and commented on as a pair. The technique used by Phillips and colleagues did not entail in situ perfusion of the organs and is, in effect, the same as that abandoned when the criteria regarding brain stem death were established.…”

mentioning

confidence: 99%

Non-heart beating organ doners for transplantation

Ferguson

Moore

Griffin

et al. 1994

BMJ

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“…Yokoyama et al, using the in situ perfusion technique of kidneys in NHBD, reported a one-year patients and graft survival of 85%, with an ATN rate of 75% (16). Varty et al, also using a double-balloon catheter reported an overall 75% graft survival (17). It appears that the results of using organs from NHBD depends on factors inherent in minimizing warm ischemic injury.…”

Section: Discussionmentioning

confidence: 99%

Experience With Liver And Kidney Allografts From Non-Heart-Beating Donors

Casavilla¹,

Ramirez²,

Shapiro³

et al. 1995

Transplantation

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Given the shortage of cadaveric organs, we began a study utilizing NHBD for OLTx and KTx. There were 24 NHBD between January 1989 and September 1993. These donors were divided into 2 groups: uncontrolled NHBD (G1) (n=14) were patients whose organs were recovered following a period of CPR; and controlled NHBD (G2) (n=10) were patients whose organs were procured after sustaining cardiopulmonary arrest (CA) following extubation in an operating room setting. Eight kidneys and 5 livers were discarded because of macroscopic or biopsy findings. In G1, 22/27 (81.5%) kidneys were transplanted; 14/22 (64%) developed ATN; 20/22 (95%) recipients were off dialysis at the time of discharge. With a mean follow-up of 32.7± 21.1 months, sixteen (73%) kidneys are still functioning, with a mean serum creatinine of 1.7±0.6 mg/dl. The one-year actuarial patient and graft survivals are 95% and 86%. In G2, 17/20 (85%) kidneys were transplanted; 13/17 (76%) kidneys experienced ATN. All patients were off dialysis by the time of discharge. With a mean follow-up of 17.6±15.4 months, twelve (70%) kidneys are still functioning, with a mean serum creatinine of 2.5±2.1 mg/dl. The one-year actuarial patient and graft survivals are 94% and 82%, respectively. In G1, 6/10 (60%) livers were transplanted; 3/6 (50%) livers functioned, the other 3 patients required ReOLTx in the first week postoperatively because of PNF(n=2) and inadequate portal flow (n=1). Two functioning livers were lost due to HAT (n=1) and CMV hepatitis (n=1). In G2, 6/7 (85.7%) livers were transplanted. All the livers (100%) functioned. 2 patients required ReOLTx for HAT at 0.9 and 1.0 months. Both patients eventually died. One patient with a functioning liver died 2 months post OLTx. The remaining 3 patients are alive and well at 27 months of follow-up. This study shows that the procurement of kidneys from both uncontrolled and controlled NHBD leads to acceptable graft function despite a high incidence of ATN. The function of liver allografts is adequate in the controlled NHBD but suboptimal in the uncontrolled NHBD, with a high rate of PNF.The concept of utilizing organ allografts from non-heart-beating donors (NHBD) * for transplantation is not new. During the 1950s and 1960s, when clinical transplantation was in its infancy, living relatives (1) and NHBD (2) were the main source of human kidney allografts, and for unpaired organs-i.e., hearts and livers; NHBD were the only source of allografts (3-5).Although the concept of brain death was first described in 1956 (6) it was not until 1968 that the guidelines for defining brain death were established and published (7). From that time until the present, brain dead HBD have been the most common source of organs for transplantation.Refinements of surgical techniques, improvements in immunosuppression, development of effective organ preservation, and broader indications have led to increasingly successful results after transplantation. However, this success has exacerbated the shortage of donor organs, and this has result...

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“…4,5 A group in Leicester used in situ perfusion to reduce damage to the organs while preparations, including obtaining permission for removal, were made (p 575) 4. A group from King's College Hospital removed the kidneys as soon after death as possible, having obtained prior permission in two thirds of cases from families and even from the donors themselves, who were dying of cerebral tumours in a hospice 5.…”

mentioning

confidence: 99%

“…Varty et al report that some kidneys were lost because of difficulties in placing the double balloon triple lumen catheters, and the number of authors of the paper suggests that the in vivo cooling technique used demanded a high level of input from skilled surgeons 4. Phillips et al compared the results of using non-heart beating donors with those of using conventional heart beating donors and report a higher mortality and lower graft survival with non-heart beating donors 5.…”

mentioning

confidence: 99%