A new study just released indicates that many donated organs that are discarded might be suitable for transplantation if certain steps are taken to limit damage following donation. The findings appear in the Journal of the American Society of Nephrology. LifeCenter Northwest’s President & CEO and study co-author, Kevin O’Connor states, “In summary, there is an opportunity to substantially and safely increase the benefit of kidney transplantation in the U.S.”
The study offers insights on how to decrease the discard rate of donated organs specifically by transplanting more kidneys from donors after circulatory death and limiting the amount of time between recovery and transplantation, or “cold ischemia” time.
In the United States, most transplanted organs come from donors declared dead by neurologic criteria (brain death). Donation after circulatory death (DCD)—in which circulation, heartbeat, and breathing have permanently stopped—has become increasingly more common, however, accounting for 17.7 percent of deceased donors in 2015 compared with only 7.3 percent in 2005. However, in some parts of the U.S., like the service area of LifeCenter Northwest, this “DCD rate” exceeds 30 percent.
To examine the contemporary use and outcomes of DCD kidneys for transplantation in the United States, John Gill, MD, MS (University of British Columbia and Vancouver’s Providence Health Care) and his colleagues examined national data obtained between 2008 and 2015. The number of DCD kidneys recovered by the country’s 58 donor service areas varied substantially (from 0 to 1072), and 25 percent of DCD kidneys were recovered in only 4 donor service areas. Overall, 20 percent of recovered DCD kidneys were discarded, varying from 3 percent to 33 percent among donor service areas.
DCD kidneys exhibited excellent organ survival, with a 5-year survival rate of 75 percent. DCD kidneys were at higher risk of failing when compared with kidneys from brain dead donors, only when the cold ischemia time was >12 hours.
“We found that use of DCD kidneys is variable throughout the United States, that the outcomes are generally excellent, and that the use of these organs could probably be safely increased if cold ischemia times are limited,” said Dr. Gill.
Study co-authors include Caren Rose, PhD, Julie Lesage, MD, Yayuk Joffres, MS, Jagbir Gill, MD, SM, and Kevin O’Connor.
Disclosures: The authors reported no financial disclosures.
The article, entitled “Use and Outcomes of Kidneys from Donation after Circulatory Death Donors in the United States,” will appear online at http://jasn.asnjournals.org/ on October 5, 2017, doi 10.1681/ASN.2017030238.
The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.
Since 1966, ASN has been leading the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients. ASN has nearly 17,000 members representing 112 countries. For more information, please visit www.asn-online.org or contact the society at 202-640-4660.