Experiences Learned in the Successful Establishment of a Nonheart Beating Donor Program for Renal Transplantation

Abstract

With the continuing shortage of suitable donors increasing interest is being shown in nonheart beating donation. Such a resource is a new and, therefore, an underused source of donor organs. However because of the nature of such donors, the kidneys so derived have been damaged by primary warm ischemia, and so potentially they may never function. We introduced viability testing to identify such organs and, thus, avoid transplantation. We reviewed sentinel cases in our developing program from which we have learned. Machine perfusion was developed locally and used to test the kidneys derived from such donors. Flow characteristics and enzyme analysis were used to define usable kidneys. The definitions of acceptable criteria evolved through the study during a 3-year period. As previously defined, acceptable criteria were initially adhered with decreasing resistance and a glutathione S-transferase of less than 200 IU/l/100 gm. After the series described acceptable limits were changed in favor of a high perfusion flow index, low temperature, low weight increase and low glutathione S-transferase. If such criteria are adhered to, graft survival becomes reliable from such donors.