The cadaveric kidney and the organ shortage - a perspective review

Despite the technical and logistical hurdles that must be overcome with the reintroduction of non-heartbeating donor kidneys, the potential of these o rgans represents the only near-term solution for effectively alleviating th e growing disparity between demand and supply. This review provides an argu mentative overview of the history of cadaveric kidney transplantation. Duri ng the early years of transplantation retrieval of kidneys from non-heartbe ating donors necessitated a prolonged period of warm ischemic exposure, wit h a corresponding minimal ex vivo period since organ preservation was in it s infancy. Today we have the inverse situation where warm ischemic times ar e limited and hypothermic preservation times average 24 h because organs ar e shipped to remote centers due to mandated organ sharing algorithms. The r ecent experience with the reintroduction of non-heart- beating donors has n ecessitated combining the worst aspects from both eras: substantial warm is chemia with prolonged hypothermic preservation. Nevertheless, recent results from several transplant groups poignantly high light the potential of this approach in expanding the organ donor pool.