The non heart-beating donor

Abstract

Given the shortage of donor kidneys for transplantation, we have focused on the use of non heart-beating (NHB) donor kidneys since 1982. The major drawback for the use of NHB donor kidneys is the inherent possibility of severe ischaemic damage leading to primary non function. Thus viability assessment of ischaemically damaged kidneys is crucial, and, therefore, a machine perfusion programme was reinstituted in 1993. Machine perfusion (MP) enables viability assessment through analysis of perfusion characteristics and measurement of enzyme release into the perfusate. Of the last 100 consecutive MP NHB donor kidneys, 71 kidneys were transplanted and 29 kidneys were discarded. Nine kidneys started functioning immediately, 51 kidneys showed delayed function and 11 kidneys never functioned. When analysing in retrospect different parameters for viability assessment, only alpha-GST, an enzyme specific for damage of proximal tubular cells within the kidney, could discriminate between functioning and non-functioning kidneys. With this promising viability assessment, the large NHB donor potential and the good transplant results, we recommend the use of these donors.

Overview of Clinical Lung Transplantation

“…At the First International Workshop on DCDs in Maastricht in the Netherlands in 1995, four types of donors were identified, socalled Maastricht categories (Table 3) (Kootstra et al 1995). Categories I (dead on arrival) and II (unsuccessful resuscitation) comprise the uncontrolled donors.…”

Outcomes of simultaneous pancreas–kidney transplantation from brain-dead and controlled circulatory death donors

“…Although donor selection was on an individual basis, relative contraindications included pancreatic trauma, hyperamylasaemia, hyperglycaemia, high insulin requirement, body mass index (BMI) greater than 30 kg/m 2 and age more than 55 years. Only controlled (Maastricht III) DCD donors were considered 8 .…”

“…Pancreas procured from donation after circulatory death (DCD) donors may offer a further alternative. DCD donors are classified as uncontrolled when cardiorespiratory arrest has occurred unexpectedly, and controlled when potential donors, for whom prolongation of treatment is considered futile, undergo planned withdrawal of life-sustaining treatment in a hospital environment, usually intensive care 8 .…”

Ex Vivo Perfusion Characteristics of Donation After Cardiac Death Kidneys Predict Long-Term Graft Survival

“…It is greater than with DBD transplants because of the primary warm ischaemia time (WIT) between cardiac arrest and perfusion of the organs. The Maastricht Category was introduced to describe the clinical characteristics of DCD donors [8,9]. Uncontrolled cardiac death (Maastricht Category I) describes donors who are declared dead outside of hospital.…”