Renal transplantation from non-heart beating donors: A promising alternative to enlarge the donor pool

The aim of this study was to compare the survival and midterm function of k idneys from non-heart beating donors (NHBD) with those of kidneys from hear t beating donors (HBD). From 1989 to 1998, 144 kidneys were procured from N HBD at the Hospital Clinico San Carlos in Madrid, of which 95 were transpla nted. The kidney grafts were maintained from the moment of the diagnosis of cardiac arrest until the time of procurement by cardiopulmonary bypass. Th ere was no significant difference in renal function and the number of rejec tion episodes between the NHBD and HBD transplants. The NHBD kidneys showed a 5.73-fold increase in the incidence of delayed graft function (adjusted relative risk 95% confidence interval, 2.82 to 11.62). One- and five-year s urvival rates for NHBD grafts were 84.6 and 82.7%, respectively, compared w ith 87.5 and 83.9% for HBD (P = 0.5767). Cox analysis showed that the predi ctive factors for worse NHBD graft survival were type of NHBD donor and the occurrence of corticoresistant rejection. Ninety of the NHBD organs were p rocured from subjects suffering irreversible cardiac arrest on the street w ho were transferred to our center for the sole purpose of donation. Fifty-f our of these kidneys were transplanted and all showed primary function. Whe n a strict protocol is adhered to, the outcome of renal transplant from NHB D compares well with that from HBD. It is believed that the high number of organs obtained from subjects undergoing irreversible cardiac arrest on the street might encourage the adoption of new criteria for the management of this type of pathology with the ultimate goal of kidney donation.