Machine perfusion for kidneys: how to do it at minimal cost

Due to a shortage of organs for transplantation, many centres use marginal grafts to increase their donor pool. As kidneys from non-heart-beating dono rs (NHBD) have sustained initial ischaemic damage, their viability is diffi cult to predict. Hypothermic pulsatile perfusion has not only been used to improve the condition of such grafts, but also allows viability assessment. Suitable systems are becoming more readily available, but they are expensi ve. We have used existing dialysis equipment with modified sterilised inser ts to create a pulsatile hypothermic perfusion system. With this system, 41 NHBD kidneys were perfused for up to 8 h; their intravascular renal resist ance (IRVR), flow characteristics as well as glutathione S transferase (GST ) measurements were performed to assess viability. This hypothermic pulsati le perfusion system is now an integral component of our NHBD programme.