Abstract
IntroductionTo counter the shortage of kidney grafts in France, a non heart beating donor (NHBD) program has recently been implemented. The aim of this study was to describe this pilot program for kidney retrieval from "uncontrolled" NHBD meaning those for whom attempts of resuscitation after a witnessed out-of-hospital cardiac arrest (CA) have failed (Maastricht 1 and 2), in a centre previously trained for retrieval from brain dead donors.MethodsA prospective, monocentric, descriptive study concerning NHBD referred to our institution from February 2007 to June 2008. The protocol includes medical transport of refractory CA under mechanical ventilation and external cardiac massage, kidney protection by insertion of an intraaortic double-balloon catheter (DBC) with perfusion of a hypothermic solution, kidney retrieval and kidney preservation in a hypothermic pulsatile perfusion machine.Results122 potential NHBD were referred to our institution after a mean resuscitation attempt of 35 minutes (20–95). Regarding the contraindications, 63 were finally accepted and 56 had the DBC inserted. Organ retrieval was performed in 27 patients (43%) and 31 kidneys out of the 54 procured (57%) have been transplanted. Kidney transplantation exclusion was related to family refusal (n = 15), past medical history, time constraints, viral serology, high vascular ex vivo resistance of the graft and macroscopic abnormalities. The 31 kidneys exhibited an expected high delayed graft function rate (92%). Despite these initial results transplanted kidney had good creatinine clearance at six months (66 ± 24 ml/min) with a 89% graft survival rate at six months.ConclusionsThis study shows the feasibility and efficacy of an organ procurement program targeting NHBD allowing a 10% increase in the kidney transplantation rate over 17 months. With a six months follow-up period, the results of transplanted kidney function were excellent.
Highlights
To counter the shortage of kidney grafts in France, a non heart beating donor (NHBD) program has recently been implemented
The program for kidney retrieval from NHBD that was initiated in our institution in 2006 (Hôpital Saint-Louis, a tertiary teaching hospital, Assistance Publique – Hôpitaux de Paris, France) was in strict agreement with the national protocol enacted by the Agence de la biomédecine
Cohort description From 1 February 2007 to 30 June 2008, 122 refractory cardiac arrests were screened in our institution
Summary
To counter the shortage of kidney grafts in France, a non heart beating donor (NHBD) program has recently been implemented. Organ transplantation programs from non heart beating donors (NHBD) have been implemented in many western countries [2,3,4,5], as well as more recently in France [6]. In contrast to many other countries, this organ retrieval program exclusively concerns uncontrolled donors [7] after sudden outof-hospital refractory cardiac arrest. This prospective, single-centre, descriptive study reports the first data from a cohort of uncontrolled NHBD referred to our Hôpital Saint-Louis from February 2007 to June 2008
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