Abstract
The results of kidney transplantation from non-heart-beating donors (NHBDs) continue to improve, and 1-year graft survival rates of 80% or greater are not unusual. Nonetheless, high rates of primary nonfunction and delayed graft function have been reported by some authors and give rise to a degree of concern. There is, therefore, a pressing need for a reliable pretransplant viability test, and current interest in focusing on normothermic machine perfusion. Immunosuppressive regimens have so far been based around the calcineurin inhibitors and there is potential for trials involving the newer non-nephrotoxic agents. The potential pool of NHBDs is very large, and some projections suggest that this source of organs is the answer to the kidney shortage problem. NHBD kidneys do, however, raise difficult ethical issues relating to the diagnosis of death by cardiac rather than brain criteria and the acceptability of in situ organ preservation procedures before family consent has been given.
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