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Non-heartbeating donation of kidneys for transplantation

Nature Clinical Practice Nephrology volume 3, pages 154–163 (2007)Cite this article

Abstract

There is a persistent shortage of kidneys available for transplantation. In the early 1980s, therefore, we published the concept of non-heartbeating (NHB) donation; that is, procurement of kidneys from donors whose death has been accompanied by irreversible circulatory arrest. NHB donors are generally categorized using four definitions; category III (awaiting cardiac arrest) and category IV (cardiac arrest while braindead)—or 'controlled'—donors are the most suitable for initiating NHB donation programs. Delayed graft function is associated with use of kidneys from such donors, but has no effect on graft survival in the short or long term. Use of kidneys from category I (dead upon arrival at hospital) and category II (unsuccessfully resuscitated), or 'uncontrolled', donors is likewise associated with delayed graft function, but also with an increased risk of primary nonfunction. Viability testing of donated organs from these sources is a prerequisite for transplantation. Machine preservation parameters and enzyme release measurements help to distinguish viable from nonviable kidneys. The proportion of NHB donor kidneys in the total pool of postmortem kidneys differs considerably between countries. In The Netherlands, the proportion is nearly 50%. This figure is markedly higher than that in the US and Canada, where national programs have now been initiated to increase rates of NHB donation. In the future, warm preservation techniques might facilitate better viability testing, thereby increasing NHB donation from category I and II donors and further reducing the shortage of kidneys available for transplantation.

Key Points

  • Use of more kidneys from non-heartbeating (NHB) donors has the potential to markedly decrease transplantation waiting times

  • Renal allografts from NHB donors are generally more likely to undergo a period of delayed function than those from heartbeating donors

  • Short-term and long-term survival of kidney grafts from NHB donors is equivalent to that of organs from heartbeating donors

  • The frequency of utilization of kidneys from NHB donors varies considerably between and within countries

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Figure 1: Numbers of postmortem kidneys transplanted in The Netherlands
Figure 2: The double-balloon triple-lumen catheter

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Authors and Affiliations

  1. G Kootstra is Emeritus Professor of Surgery at the University of Maastricht, and E van Heurn is Associate Professor of Surgery, University Hospital Maastricht, Maastricht, The Netherlands.,

    Gauke Kootstra & Ernest van Heurn

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  1. Gauke Kootstra
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Correspondence to Gauke Kootstra.

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Kootstra, G., van Heurn, E. Non-heartbeating donation of kidneys for transplantation. Nat Rev Nephrol 3, 154–163 (2007). https://doi.org/10.1038/ncpneph0426

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