IN-SITU PRESERVATION OF KIDNEYS FROM NON-HEART-BEATING DONORS - A PROPOSAL FOR A STANDARDIZED PROTOCOL

The growing success in renal transplantation has resulted in an increa se in the need for donor organs. Procurement of kidneys from heart-bea ting (HB) donors is unlikely ever to meet this demand. Non-heart-beati ng (NHB) donors offer a yet untapped source of renal grafts. Cadaver k idneys from patients who have sustained cardiac standstill are often c onsidered unsuitable for transplantation due to prolonged warm ischemi a time. Using an emergency in situ perfusion technique it is possible to limit warm ischemic damage and to salvage these kidneys for transpl antation. The procedure requires prompt action and cooperation of emer gency service personnel. This report presents a protocol for the emerg ency in situ preservation procedure that can be practiced in most hosp itals. At the University Hospital of Maastricht, The Netherlands, impl ementation of this procedure resulted in 20% more kidneys available fo r transplantation. Although NHB donor kidneys showed a higher rate of delayed function compared with a matched HB donor kidney population, t here was no significant difference in long-term graft survival between the two groups.