Use of non-heart-beating donors in renal transplantation

Abstract

The rate of renal transplantation has plateaued and is now limited by the number of donor organs available. In the past all donor kidneys came from living donors or controlled non-heart beating donors. It was not until the introduction of brainstem death criteria that cadaveric heart beating donors became the main source. Recently, there has been renewed interest in non-heart beating donors, who have already suVered cardiorespiratory arrest. Kidneys from these donors have a unique set of problems associated with increased duration of warm ischaemia. To minimise this, the kidneys are cooled in situ using an intra-aortic balloon catheter and are perfused with cold hyperosmolar citrate. Retrieval can then proceed in the normal fashion. Despite a higher level of delayed graft function, the results from non-heart beating renal transplantation are good, with long term function comparable to cadaveric organs. If used safely, they enable significant expansion of the donor pool. Techniques in the future, such as machine perfusion preservation, may further improve the results from non-heart beating programmes. (Postgrad Med J 2001;77:681-685)

Receptores de trasplante renal de donantes en asistolia y muerte cerebral: diferencias en los cuidados enfermeros

“…Para el análisis de nuestro estudio debemos considerar que el tamaño de la muestra es relativamente pequeño y que las características clínicas que pueden influir en la evolución funcional de los injertos son muy diversas, a saber, causa de muerte del donante, tipo de parada cardiaca, técnica de preservación, edad del donante y del receptor, trasplantes previos, diferentes protocolos de inmunosupresión, etc 7 . Todo esto hace que los resultados deban ser interpretados con cautela.…”

The Effect of Edaravone on Liver Damage in Controlled Experimental Non-Heart-Beating Donor Model

“…Bu donörlerin karmaşık süreçlerinin greft survey ve fonksiyonlarına yansıyan kötü yanları geliştirilen stratejiler ile düzeltilebilirse NHBD'ler organ havuzunu çözmekte çok daha önemli rol oynayacaklardır. Tahminler, NHBD'lerin organ havuzuna her yıl yaklaşık 1000 donör eklenmesiyle kadaverik organ havuzunu potansiyel olarak %25-42 oranında arttıracağını göstermektedir (17,18).…”

Caracterización histológica y hemodinámica del injerto con isquemia caliente según el método de preservación

“…Los riñones obtenidos de DCP tienen una mayor tasa de disfunción inicial del injerto, aunque a largo plazo la función del mismo sea equiparable a los obtenidos de donantes a corazón batiente 37 . La formación de radicales libres de oxígeno aumenta la inmunogenidad del injerto facilitando el rechazo del mismo 38 .…”