1. ¹Department of Pathology and Laboratory Medicine, University of Groningen, Groningen, The Netherlands
2. ²Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

Correspondence: RJ Ploeg, Department of Surgery, University Medical Center Groningen, Hanzeplein 1, Groningen 9713 GZ, The Netherlands. E-mail: R.J.Ploeg@chir.umcg.nl

Received 3 October 2006; Revised 3 May 2007; Accepted 8 May 2007; Published online 25 July 2007.

Abstract

Major improvements in immunosuppressive treatment, surgical techniques, and treatment of post-transplant complications have contributed considerably to improved outcome in renal transplantation over the past decades. Yet, these accomplishments have not led to similar improvements in transplant outcome when the results of living and deceased donors are compared. The enormous demand for donor kidneys has allowed for the increase in acceptance of suboptimal donors. The use of brain dead patients as organ donors has had a tremendous positive influence on the number of renal transplants. Unfortunately, the physiologically abnormal state of brain death has a negative effect on transplant outcome. The fact that transplanted kidneys derived from brain dead donors have a decreased viability indicates that potential grafts are already damaged before retrieval and preservation. In this review, we present an overview of the current knowledge of (patho)-physiological effects of brain death and its relevance for renal transplant outcome. In addition, several options for therapeutic intervention during brain death in the donor with the goal to improve organ viability and transplant outcome are discussed.