Copyright ©2012 Baishideng. All rights reserved.
World J Nephrol. Jun 6, 2012; 1(3): 79-91
Published online Jun 6, 2012. doi: 10.5527/wjn.v1.i3.79
Kidney donation after cardiac death
Jacob A Akoh
Jacob A Akoh, South West Transplant Centre, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth PL6 8DH, United Kingdom
Author contributions: Akoh JA solely contributed to this paper.
Correspondence to: Jacob A Akoh, FRCSEd, FRCS (Gen), Consultant General and Transplant Surgeon, Level 04, South West Transplant Centre, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth PL6 8DH, United Kingdom.
Telephone: +44-1752-439798 Fax: +44-1752-774651
Received: December 26, 2011
Revised: May 23, 2012
Accepted: June 1, 2012
Published online: June 6, 2012

There is continuing disparity between demand for and supply of kidneys for transplantation. This review describes the current state of kidney donation after cardiac death (DCD) and provides recommendations for a way forward. The conversion rate for potential DCD donors varies from 40%-80%. Compared to controlled DCD, uncontrolled DCD is more labour intensive, has a lower conversion rate and a higher discard rate. The super-rapid laparotomy technique involving direct aortic cannulation is preferred over in situ perfusion in controlled DCD donation and is associated with lower kidney discard rates, shorter warm ischaemia times and higher graft survival rates. DCD kidneys showed a 5.73-fold increase in the incidence of delayed graft function (DGF) and a higher primary non function rate compared to donation after brain death kidneys, but the long term graft function is equivalent between the two. The cold ischaemia time is a controllable factor that significantly influences the outcome of allografts, for example, limiting it to < 12 h markedly reduces DGF. DCD kidneys from donors < 50 function like standard criteria kidneys and should be viewed as such. As the majority of DCD kidneys are from controlled donation, incorporation of uncontrolled donation will expand the donor pool. Efforts to maximise the supply of kidneys from DCD include: implementing organ recovery from emergency department setting; improving family consent rate; utilising technological developments to optimise organs either prior to recovery from donors or during storage; improving organ allocation to ensure best utility; and improving viability testing to reduce primary non function.

Keywords: Donation after cardiac death, Donation after brain death, Extended criteria donor, Viability assessment, Renal transplantation, Delayed graft function, Graft survival, Agonal phase, Kidney preservation