Non-heart-beating Donors Research Articles

Uncontrolled non-heartbeating donors (types I–II) with normothermic recirculation vs. heartbeating donors: Evaluation of functional results and survival

ObjectiveNon-heartbeating donors (NHBD) are an alternative to heartbeating donors (HBD). Our objective was to compare functional results and kidney survival from NHBDs and HBDs. Material and methodsA retrospective study comparing the results of 236 normothermically preserved kidneys from type I and type II NHBDs with the results of 250 from HBDs that were transplanted in our center between 2005 and 2012. Homogeneity between groups was tested and we evaluated the presence of delayed graft function (DGF) associated with pretransplant variables of the donor and recipient. ResultsBoth groups show homogeneity in pretransplant characteristics in terms of: age, HLA incompatibilities, and recipient hemodialysis time. Average follow-up time was 33 months (range 0–87) for NHBDs and 38 months (range 0–90) for HBDs. 5.5% of NHBDs showed primary non-function (PNF) vs. 4% of HBDs (p=0.42) and 80.9% of DGF vs. 46.8% of HBDs (p<0.001). At the end of the follow-up, there were no statistically significant differences in the survival of grafts (92.8% for NHBD vs. 93.6% for HBD, p=0.71) and recipients (99.1% NHBD vs. 98.6% HBD, p=0.28). ConclusionsAlthough the DGF percentage was greater for NHBDs, final creatinine as well as graft and recipient survival were similar for both groups. Therefore, in our experience, kidneys from NHBDs have similar results to those from HBDs and are an excellent source of organs for transplantation.

COMPARISON OF THE EFFECTIVENESS OF METHODS FOR BONE MARROW HARVESTING FROM NON-HEART BEATING DONORS

Aim. To compare the effectiveness of different methods for bone marrow (BM) harvesting from non-heart beating donors taking into account the number and the quality of collected hematopoietic stem cells (HSC).Materials and methods.The study was performed on 43 non-heart beating donors. For BM harvesting two bone marrow aspiration needles were installed in each iliac bone. The needles were installed in one bone connected to closed system, combined with surgical suction and volumetric pump. BM aspiration was performed using different values for vacuum and combining with perfusion solution into the bone. The volume, the number of nucleated cells (NC), HSC and cell viability were evaluated in the obtained samples.Results.Compared with the standard mode the usage of vacuum 0.6–0.7 atm increased the collection of NC by 65.6%, HSC 87%, and did not reduce their viability. Using a vacuum of 0.9 atm reduced the amount of collected HSC and damaged cells. While using combined aspiration and perfusion of BM HSC were prepared at more than 86.2%, but the viability of the cells was lower than under the standard aspiration. Having coherently performed a standard aspiration and aspiration with perfusion from one iliac bone 407.2 ± 46.7 ml BM, 8.0 ± 0.8 × 109 NC and 194.2 ± 20.8 × 106 HSC were harvested. The proportion of viable cells was not less than 75.2 ± 3.2%.Conclusion.Method of BM harvesting implying coherently performing aspiration and aspiration-perfusion with the usage of vacuum 0.6–0.7 atm allows to prepare more progenitor cells without losing their quality. As a result, from one non-heart beating donor different types of progenitor cells can be collected in the amount sufficient for systemic infusion in adult patient.

A Successful Transplantation from Maastricht Category-4 Non-Heart Beating Donor

The shortage of available organs is the limiting factor for kidney transplantation (Ktx). One of the strategies to increase access to Ktx is the use of non-heart beating (NHB) donors. We herein present a successful Ktx from an NHB (Maastricht Category-4) donor. The donor was a 21-year-old woman who had brain death due to cerebrovascular accident. She had severe hypotension for three hours despite 30 μg/kg/min dopamine infusion, followed by cardio-pulmonary arrest just before the operation began. Cardio-pulmonary resuscitation was consequently initiated and continued during the operation. Donor organ harvesting (hepatectomy and bilateral nephrectomy) was performed after direct aortic cannulation. The warm ischemia time was 35 minutes. The recipient was a 54-year-old man who had undergone hemodialysis for four years. There were 3/6 mismatches, and the lymphocyte cross-match was negative. The induction immunosuppressive was anti-thymocyte globulin, followed by tacrolimus/ MMF/steroid after the 12th day. He had delayed graft function and hemodialysis was required at the third and sixth days. The urine output gradually increased and sCr slowly declined afterwards and he discharged with sCr 1.5 mg/dl on the 24th day. At the first year of transplantation, he is in good clinical condition with a stable baseline sCr of 1.5 mg/dl. NHB donors can be an alternative and important source to expand the kidney donation pool, and successful long-term outcomes favor this modality.

Multipronged strategy of purposeful use of organs from non-heart beating donors

Multipronged strategy of purposeful use of organs from non-heart beating donors

Retrograde Oxygen Persufflation of Kidney: Experiment on an Animal

Objective: There is still a lack of organs for transplantation purposes. In the field of kidney and liver transplantation one of available solutions is the use of organs from so-called marginal donors. These donors can be e.g. non-heartbeating donors (NHBD). In these cases perfusion and preservation of organs intended for transplantation is generally more difficult. Retrograde oxygen persufflation (ROP) may be one of the possible solutions of this issue. This method is based on retrograde perfusion by oxygen through the renal vein thus reconditioning the organ.Materials and methods: We have operated on 10 animals (porcine models). In all animals was simulated ischemic injury of right kidney. In Group A (N=5) were kidneys after explantation perfused with retrograde oxygen persufflation. In group B (N=5) were kidneys perfused intrarterialy like usually in clinical practice. After perfusion were all kidneys again transplanted to the same animal. Quality of graft restitution was evaluated by urea level taken from renal vein and by histopathological analysis after explantation.Results: We have found no statistically significant differences between the groups A and B in urea levels after transplantation as wel as we have found no significant differences in quality of kidney parenchyma restoration in both groups.Conclusions: Retrograde oxygen persufflation is able to protect and restore kidney parenchyma.

The protective effect of hypercapnia on ischemia-reperfusion injury in lungs

Lifesaving therapy for patients with end-stage lung disease is lung transplantation. However, there are not enough available donors. A relatively new method of transplantation from non-heart-beating donors (NHBDs) allows the treatment of the lung outside the body and could increase the number of suitable lungs. We have focused on hypercapnic ventilation, which has the possibility of reducing reactive oxygen species damage.We used four experimental and two control groups of adult rats. Each experimental group underwent the protocol of NHBD lung harvesting. The lungs were than perfused in an ex vivo model and we measured weight gain, arterial-venous difference in partial pressure of oxygen and perfusion pressure.We observed that hypercapnic ventilation during reperfusion reduces the development of pulmonary oedema and has a protective effect on the oxygen transport ability of the lungs after warm ischemia. The effect of CO2 on pulmonary oedema and on oxygen transport ability after warm ischemia could be of clinical importance for NHBD transplantation.

OR35: THE DYNAMICS OF SERUM FREE LIGHT CHAIN IMMUNOGLOBULINS AFTER KIDNEY TRANSPLANTATION

Patients developing end stage renal disease (ESRD) are characterized by an accumulation of metabolic waste products in the blood. The majority of these waste products are efficiently removed during dialysis. However, kappa and lambda serum free light chain immunoglobulins (sFLC Igs) that are overproduced (10 to 40%) by all human plasma cells remain in the blood circulation of dialyzing patients. Normally, these sFLC Igs are internalized in the proximal tubules of the kidneys by low-affinity, high capacity receptors that provoke sFLC Ig proteolysis and therefore reflect kidney function. Notably, oversaturation of this process by elevated sFLC Ig levels leads to cast formation in the distal tubule that induces further kidney damage in patients with ESRD. For these reasons we investigated the dynamics of kappa and lambda sFLC Igs in the blood of patients receiving kidney transplantation and whether sFLC Ig levels reflect kidney function. We show that the serum levels of kappa and lambda FLC Igs are elevated in all tested patients awaiting kidney transplantation as compared to healthy controls, indicating that dialysis and the alternative sFLC Ig removal mechanism of the liver fail to maintain normal sFLC Ig levels. This elevation was irrespective of immunization status of the patient. Upon kidney transplantation we observe a rapid decrease of sFLC Ig levels in 23 out of 25 patients with immediate graft function and we show intermediate decrease of sFLC Ig levels in 15 out of 23 patients with delayed graft function. In general we observe faster normalization of kidney function in patients receiving an organ of living donors as compared to postmortem donors. In the latter group the heartbeating organs show faster sFLC Ig normalization as compared to non-heartbeating donors, which also reflects kidney function. Taken together our data illustrate that kappa and lambda sFLC Ig levels reflect kidney function in immunized and non-immunized patients after kidney transplantation. At present we are investigating whether sFLC Igs are a more sensitive biomarker for rejection or delayed kidney function.

Emergency medical services knowledge and attitudes about non-heart-beating donors: Effect of an educational intervention

More than 750,000 people die of sudden death each year, and many are potential non-heart-beating donors (NHBDs) for lung transplant. Although critical, the role of emergency medical services (EMS) personnel in assisting with recovery of NHBD lungs has not been studied. The purpose of this study was to assess knowledge of and attitudes about NHBDs among EMS personnel, evaluate the extent to which knowledge and personal experience with organ donation is associated with attitude, and ascertain the effectiveness of an intervention designed to teach EMS professionals about NHBDs. EMS professionals (n = 361) completed measures of knowledge of and attitudes about NHBDs and then watched a presentation by a transplant doctor about traditional organ donation, NHBDs, and transplantation. Participants were able to ask questions during and after the presentation. Participants completed the measures again 3 months later. EMS professionals had a high rate of personal experience with organ donation and positive attitudes toward traditional organ donation. However, they showed lack of knowledge about NHBDs and felt less skilled in being part of the NHBD process, consistent with knowledge scores. The educational intervention was somewhat effective in improving knowledge about NHBDs. Scores improved significantly on 5 of 13 items. Lung recovery from NHBDs offers the potential of a very large supply for transplantation. This research suggests that with additional training, EMS professionals may be willing to be part of a NHBD recovery team.

Iron-induced oxidative rat liver injury after non-heart-beating warm ischemia is mediated by tumor necrosis factor α and prevented by deferoxamine.

This study investigated iron-induced injury after warm ischemia in a non-heart-beating (NHB) rat liver model and the effects of deferoxamine (DFO). Livers from heart-beating (HB) rats or rats that were NHB for 60 minutes were stored in University of Wisconsin solution for 5 hours at 4°C [cold storage (CS)] and then were subjected to 2 hours of machine reperfusion (MRP) at 37°C. Three NHB groups were compared: (1) no DFO, (2) DFO 30 minutes before cardiac arrest and during CS and MRP, and (3) DFO during CS and MRP. Aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) levels in the NHB perfusate were significantly elevated (P < 0.01) in comparison with levels in HB controls after CS and MRP. After CS, the levels of iron and tumor necrosis factor α (TNF-α) were 0.077 ± 0.007 μmol/g and 151 ± 26 pg/g, respectively, in the NHB group and 0.022 ± 0.004 μmol/g and 17 ± 7 pg/g, respectively, in the HB group (P < 0.01). After MRP, LDH significantly correlated with iron (R(2) = 0.81, P < 0.01). The DFO pretreatment of NHB donors decreased AST (7.3 ± 0.8 versus 4.0 ± 0.5 U/g of liver, P < 0.05) and LDH (42.5 ± 4.1 versus 20.4 ± 2.5 U/g of liver, P < 0.05) with 2 hours of MRP and increased bile flow during MRP (142 ± 34 versus 240 ± 18 μL/g, P < 0.05). It also reduced the levels of iron (0.077 ± 0.007 versus 0.050 ± 0.008 μmol/g, P < 0.05) and TNF-α (151 ± 26 versus 51 ± 13 pg/g, P < 0.05) after CS and the levels of lipid peroxidation products F2-isoprostane (149 ± 11 versus 99 ± 10 ng/g, P < 0.05) and malondialdehyde (1.58 ± 0.1 versus 1.14 ± 0.08 μmol/g, P < 0.05) after MRP. In conclusion, iron-initiated oxidative stress is likely involved in NHB donor liver injury, and importantly, DFO pretreatment reduces liver damage.

The Effects of Hydrogen Gas Inhalation On Non-Heart-Beating Donor Lung During Ex Vivo Lung Perfusion.

Purpose: The shortage of donor lung is a limiting factor in lung transplantation (LTx). In order to resolve this problem, non-heart-beating donor (NHBD) lungs are evaluated in ex vivo lung perfusion (EVLP) system prior to LTx. In this study, the effects of hydrogen gas inhalation on NHBD lungs were investigated during EVLP. Methods: Ten 40kg female pigs were randomly divided into control (n=5) and study group (n=5). After cardiac arrest and one hour of warm ischemic injury, the lungs were harvested after flushing with Perfadex solution, and the lungs assessed in the EVLP system for 4 hours. Steen solution was used as perfusate. During EVLP, the lungs were ventilated in the control group with room air (0.2 of FiO2), and with 2% hydrogen gas in the study group. Oxygen capacity, pulmonary vascular resistance and peak airway pressure were measured every hour for 4 hours during EVLP. After the EVLP, lung specimens were excised for measurement of p38, JNK, and ERK 1/2 phosphorylation, and the expression of IL-1ß, IL-6, IL-8, and TNF-α. Pathologic evaluation was performed using lung injury severity score after H & E stain, and wet/dry ratio was examined. Results: Oxygen capacity in the study group was higher than the control group but did not show a significant difference (p = 0.0862). However, pulmonary vascular resistance (p = 0.0111) and peak airway pressure (p = 0.0189) were significantly lower in the study group. The extents of phosphorylation of p38, JNK, and ERK 1/2 were lower in the study group, but did not show statistically significant difference. The expression of IL-1ß (p = 0.0317), IL-6 (p = 0.0159), IL-8 (p = 0.0195), and TNF-α (p = 0.0159) were all significantly lower in the study group. Lung injury score (p = 0.0358) and wet/dry ratio (p = 0.040) were also lower in the study group.Conclusion: Inhalation of hydrogen gas in NHBD lungs during EVLP may improve the function of damaged lungs, and might possibly increase the utilization of NHBD lungs.

Organ transplantation. Questions in the interface of ethics and anthropology

In the field of organ transplantation medical ethics is confronted with a number of problems where the particular difficulty lies in the fact that ethical and anthropological questions interpenetrate. This article discusses two of these problems in this interface both of which are highly controversial: the real or apparent contradiction between the dead-donor rule and the traditional definition of death and the real or apparent contradiction between the ethical desirability of harvesting organs from non-heart beating donors and the irreversibility of brain death.

Edaravone, a Free Radical Scavenger, Improves the Graft Viability on Liver Transplantation From Non–heart-beating Donors in Pigs

BackgroundAlthough liver transplantation from non–heart-beating donors (NHBDs) is an effective way to overcome shortage of donors, primary graft nonfunction is often noted in these grafts. We have previously reported that edaravone, a free radical scavenger, has a cytoprotective effect on warm ischemia-reperfusion injury and improves the function of liver grafts from NHBDs in a rat model of ischemia-reperfusion. The purpose of this study was to investigate the effects of edaravone on liver transplantations from NHBDs. MethodsPigs were divided into three groups: (1) a heart-beating (HB) group (n = 5), in which liver grafts were retrieved from HB donors; (2) a non-heart-beating (NHB) group (n = 4), in which liver grafts were retrieved under apnea-induced NHB conditions; and (3) an edaravone-treated (ED) group (n = 5), in which liver grafts were retrieved in the same manner as the NHB group and treated with edaravone at the time of perfusion (3 mg/L in University of Wisconsin [UW] solution), cold preservation (1 mg/L in UW solution), and after surgery (1 mg/kg/d). The grafts from all groups were transplanted after 4 hours of cold preservation. ResultsIn the ED group, the 7-day survival rate was significantly higher than that in the NHB group (80% versus 0%, P = .0042, Kaplan-Meier log-rank test). Furthermore, on histologic examination, the structure of sinusoids in the ED group was well preserved and similar to that in the HB group. ConclusionsEdaravone may improve the viability of liver grafts from NHBDs.

IV Consensus Meeting of the Spanish Society of Liver Transplantation (SETH) 2012. Liver Transplant With Non-Conventional Grafts: Split Liver Transplantation and Non-Heart Beating Donors

The disbalance between the number of candidates to liver transplant and the number of liver grafts leads to waiting list mortality. Two potential ways of increasing the number of liver grafts are split liver transplantation and the transplantation of grafts from non-heart beating donors. Both of them were discussed in a consensus meeting of the Spanish Society of Liver Transplantation in October 2012. This paper outlines the conclusions of that meeting.

Hepatobiliary Quiz—9 (2014)

1.Regarding acute hepatitic illnesses in patients with chronic hepatitis B (CHB) infection the following are TRUE:1.Most common cause is flare of hepatitis B2.Flare of hepatitis B is more common in HBeAg negative individuals3.Flares of hepatitis B can be due to activation of immune system or due to reactivation of hepatitis B virus4.Reactivation of hepatitis B virus invariably occurs in the setting of immunosupression5.Reactivation of hepatitis B virus does not occur in HBsAg negative patients2.Regarding differentiation of acute hepatitis B infection from flare of chronic hepatitis B the following are TRUE EXCEPT:1.Presence of serum IgM anti-HBc is pathognomonic for acute hepatitis B infection2.In acute hepatitis B infection the 19s subtype of IgM anti-HBc is more common3.IgG anti-HBc can be seen in both acute hepatitis B as well as reactivation of chronic hepatitis B infection4.Hepatitis B DNA levels are higher in acute hepatitis B infection5.HBsAg and HBeAg titres are lower in acute hepatitis B infection3.Regarding pathogenesis and clinical features of Wilson disease the following are TRUE:1.Wilson disease occurs due to mutations in ATP7A gene2.Wilson disease is inherited in an autosomal recessive pattern3.Wilson disease has a definite phenotype–genotype correlation4.Liver disease manifests at earlier age than neurological disease5.Most patients with neurological presentation of Wilson disease will have underlying liver disease4.Regarding the diagnosis of Wilson disease the following are TRUE:1.Kayser–Fleischer ring is almost universally present in patients with neurological Wilson disease2.Total serum copper is reduced in Wilson disease3.Low ceruloplasmin levels are specific for Wilson disease4.d-Penicillamine challenge test is useful to diagnose Wilson disease in adults and asymptomatic siblings of affected patients5.Testing for H1069Q mutation is useful to establish the diagnosis in Indian patients5.Regarding treatment of Wilson disease the following are TRUE EXCEPT:1.Zinc acts by increasing urinary excretion of copper2.d-Penicillamine may cause initial worsening of neurological symptoms3.Trientine is contraindicated in patients intolerant to d-Penicillamine4.Ammonium tetrathiomolybdate may be useful for patients whose neurological disease worsens with other chelators5.Development of anemia or leukopenia during chelation therapy may be due to copper deficiency6.Regarding the pathophysiology of neonatal hemochromatosis the following are TRUE:1.Neonatal hemochromatosis is a hereditary disorder2.Gestational alloimmune liver disease (GALD) is the probable cause of neonatal hemochromatosis3.GALD is an IgM mediated disease4.Complement mediated hepatocyte injury via the classical pathway is the hallmark of GALD5.Histopathological changes are panlobular, and typically spare the portal tracts7.Regarding presentation and diagnosis of neonatal hemochromatosis the following are TRUE:1.Most cases will present after few weeks of birth with liver failure2.Hepatic transaminase levels are very high3.α-fetoprotein levels are very high4.Serum ferritin is very high and transferrin levels are low5.Presence of extrahepatic siderosis is helpful in making the diagnosis8.Regarding treatment and prevention of neonatal hemochromatosis the following are TRUE:1.Iron chelators are useful2.Plasma exchange and intravenous immunoglobulin (IVIg) are therapy of choice3.Liver injury in neonatal hemochromatosis is irreversible with therapy4.Liver transplantation has excellent success rates5.Women with prior affected babies should receive IVIg prophylaxis in subsequent pregnancies9.Regarding donor selection for deceased donor liver transplantation the following are TRUE EXCEPT:1.The ideal donor is less than 40 years of age and has trauma as cause of death2.Ideal donor includes donation after cardiac death3.Ideally the serum sodium of the donor should be below 150 mEq/L4.Exogenous hormone therapy like thyroid hormones and corticosteroids given prior to organ procurement in brain dead donors improves transplantation outcomes5.The Model for End-stage Liver Disease (MELD) score is the best predictor of post-transplant outcomes10.Regarding extended criteria donors for deceased liver transplantation the following are TRUE:1.Cold ischemia time is an important determinant of post-transplant outcomes in grafts from extended criteria donors2.High levels of hepatic transaminases in the donor are a contraindication for liver donation3.The risk of transmission of malignancy via hepatic graft is about 1%4.Organs from donors with previously treated low grade malignancies may be considered for transplantation5.Outcomes from liver grafts from non-heart beating donors are invariably poor

Effects of exogenous surfactant on the non‐heart‐beating donor lung graft in experimental lung transplantation – a stereological study

The use of non-heart-beating donor (NHBD) lungs may help to overcome the shortage of lung grafts in clinical lung transplantation, but warm ischaemia and ischaemia/reperfusion injury (I/R injury) resulting in primary graft dysfunction represent a considerable threat. Thus, better strategies for optimized preservation of lung grafts are urgently needed. Surfactant dysfunction has been shown to contribute to I/R injury, and surfactant replacement therapy is effective in enhancing lung function and structural integrity in related rat models. In the present study we hypothesize that surfactant replacement therapy reduces oedema formation in a pig model of NHBD lung transplantation. Oedema formation was quantified with (SF) and without (non-SF) surfactant replacement therapy in interstitial and alveolar compartments by means of design-based stereology in NHBD lungs 7 h after cardiac arrest, reperfusion and transplantation. A sham-operated group served as control. In both NHBD groups, nearly all animals died within the first hours after transplantation due to right heart failure. Both SF and non-SF developed an interstitial oedema of similar degree, as shown by an increase in septal wall volume and arithmetic mean thickness as well as an increase in the volume of peribron-chovascular connective tissue. Regarding intra-alveolar oedema, no statistically significant difference could be found between SF and non-SF. In conclusion, surfactant replacement therapy cannot prevent poor outcome after prolonged warm ischaemia of 7 h in this model. While the beneficial effects of surfactant replacement therapy have been observed in several experimental and clinical studies related to heart-beating donor lungs and cold ischaemia, it is unlikely that surfactant replacement therapy will overcome the shortage of organs in the context of prolonged warm ischaemia, for example, 7 h. Moreover, our data demonstrate that right heart function and dysfunctions of the pulmonary vascular bed are limiting factors that need to be addressed in NHBD.

IV Reunión de consenso de la Sociedad Española de Trasplante Hepático (SETH) 2012. Trasplante hepático con injertos no convencionales: bipartición hepática (split) y donante en asistolia

The disbalance between the number of candidates to liver transplant and the number of liver grafts leads to waiting list mortality. Two potential ways of increasing the number of liver grafts are split liver transplantation and the transplantation of grafts from non-heart beating donors. Both of them were discussed in a consensus meeting of the Spanish Society of Liver Transplantation in October 2012. This paper outlines the conclusions of that meeting.

Use of donor bladder tissues for in vitro research

To evaluate deceased non-heart beating (DNHB) donors and deceased heart beating (DHB) brain-stem dead donors, as sources of viable urological tissue for use in biomedical research. To identify sources of viable human bladder tissue as an essential resource for cell biological research aimed at understanding human diseases of the bladder and for developing new tissue engineering and regenerative medicine strategies for bladder reconstruction. Typically, normal human urinary tract tissue is obtained from adult or paediatric surgical patients with benign urological conditions, but few surgical procedures yield useful quantities of healthy bladder tissue for research. Research ethics committee approval was obtained for collection of donor bladder tissue. Consent for DHB donors was undertaken by the Donor Transplant Coordinators. Tissue Donor Coordinators were responsible for consent for DNHB donors and the retrieval of bladders was coordinated through the National Blood Service Tissue Banking Service. All retrievals were performed by practicing urologists and care was taken to maintain sterility and to minimise bacterial contamination. Two bladders were retrieved from DNHB donors and four were retrieved from DHB donors. By histology, DNHB donor bladder tissue exhibited marked urothelial tissue damage and necrosis, with major loss or absence of urothelium. No cell cultures could be established from these specimens, as the urothelial cells were not viable in primary culture. Bladder urothelium from DHB donors was intact, but showed some damage, including loss of superficial cells and variable separation from the basement membrane. All four DHB bladder specimens yielded viable urothelial cells that attached in primary culture, but cell growth was slow to establish and cultures showed a limited capacity to form a functional barrier epithelium and a propensity to senesce early. We have shown that normal human bladder urothelial cell cultures can be established and serially propagated from DHB donor bladders. However, our study suggests that rapid post-mortem changes to the bladder affect the quality and viability of the urothelium, rendering tissue from DNHB donors an inadequate source for urothelial cell culture. Our experience is that whereas patients are willing to donate surgical tissue for research, there is a barrier to obtaining consent from next of kin for retrieved tissues to be used for research purposes.

Obstacles of Non–heart-beating Donor Kidney Transplantation in Japan to Date and Future Perspectives

In Japan, multiple organ retrieval from brain-dead heart-beating donors has been gradually increasing since the law was adopted in 1997 and amended in 2009. However, almost more than 90% of total deceased donor kidney transplantation (DDKT) in Japan are still obtained from non–heart-beating donors (NHBD). The majority of NHBD are Maastricht categories IV and III. In category IV, we usually place a double balloon arterial and a venous drainage catheter via the femoral vessels after the diagnosis of clinical brain death and acquisition of informed consent from the family. After controlled cardiac arrest, the double balloons are inflated and in situ cold perfusion started as soon as possible to minimize warm ischemic time (WIT), seeking to achieve a zero to within a few minutes WIT in most cases. In category III, it is impossible to place the device prior to cardiac arrest. In these cases, after declaration of cardiac death, cardiopulmonary compression is accompanied by systemic heparinization, immediate laparotomy, and insertion of a cold perfusion catheter at the aortic and caval bifurcations to minimize WIT. NHBD kidney retrieval is critical; extirpation must be performed as rapidly as possible. The results of NHBD kidney transplantation in Japan are excellent, according to the advancement and utilization of in situ cannulation, organ perfusion, and sophisticated retrieval techniques. The patient and graft survival rates of DDKT at 1, 3, and 5 years in most recent 2001 to 2007 era were 95.4%, 92.2%, 89.1% (n = 945) and 89.2%, 83.7%, 77.8% (n = 919), respectively.

Prélèvement rénal sur donneur décédé par arrêt cardiaque (DDAC) : organisation dans un centre hospitalier non universitaire

In 2011 in France, all kidneys from patients with brain death and from living donors cannot meet the demand for renal transplants. Since 2006, sampling protocols kidneys from non-heart-beating donors (NHBD) are developed to increase the number of renal transplants. The objective was to describe the organization of a protocol NHBD in a non-university hospital. Patients with inclusion criteria of protocol NHBD of the Agency of Biomedicine were prospectively included between 1st July 2011 and 31 December 2012. The protocol data were comparable to national data. Vascular canulation was performed by urologists. The epidemiological, clinical and biological characteristics of patients included, the different times and deadlines of the protocol, and data of renal transplantation were collected and analyzed. Over the period of 18 months, 16 patients were included in the protocol NHBD, with a median age of 42 years, and 87.5% of males; 93.8% of patients made a cardiac arrest outside the hospital. The median duration of no-flow was 4.3 minutes (0; 23), the median time between the cardiac arrest and admission to hospital was 90 minutes (0; 116), the median time between the cardiac arrest and the start of the normothermic recirculation was 139 minutes (40; 150), and the median duration of normothermic recirculation was 212 minutes (186; 240). For urologists, the median duration of mobilization was 178 minutes and 97 minutes after 20 h. Twenty-four kidneys were collected (75%) and 22 kidneys were transplanted (91.7%). The median duration of cold ischemia was 9 h 12 (5 h 25; 18 h 02). No primary non-function of graft was observed. Delayed graft function was observed in 50% of cases and the median duration of dialysis was 2 days (0; 19). After 12 months of inclusion, our center accounted for 8% of the national census and 16% of transplanted kidneys NHBD. The involvement of rescue, coordination, anesthesiologists and urologists, and the concentration of jobs in our center have helped to minimize response times NHBD in the protocol for maximum quality of kidneys taken with transplant rates and results are very encouraging.

Alpha code. The start of a new non-heart beating donor program

Abstract Objective To present the preliminary results of a non-heart beating donor (NHBD) program in a city of under 500,000 inhabitants. Design A prospective observational study was conducted between 2010 and 2011. Setting Virgen de las Nieves Hospital and metropolitan area of Granada (Spain). Population NHBD and brain dead donors (BDD) in the province of Granada during 2010 and 2011. Study variables Characteristics of NHBD, out- and in-hospital times, family and legal refusals, preservation methods, and family information procedure. Organs: reasons for organ non-validness, and harvested and transplanted organs. Recipients: hemodialysis sessions and creatinine at discharge. BDD: number of real donors (RD) and of kidney transplants. Results Among the BDD there were 102 RD and 104 kidney transplants were carried out. In asystole, 22 potential donors, 21 eligible donors, 20 RD and 13 used donors were registered. The mean age among the RD was 50 years (range 33–62) (16 males and 4 females). Twenty-one kidney and two liver transplants from NHBD were performed. There were a number of reasons for organ non-validness. The mean number of post-transplantation hemodialysis sessions was 1.4 (range 0–6). The mean hospital stay was 25 days (range 14–41), and the mean creatinine concentration at discharge was 3.4 mg/dl (range 1.5–6.4). There was one family rejection and no legal (court-ruled) rejections. The preservation methods and family information procedure are described. Conclusions The preliminary results support the development of NHBD programs in cities with under 500,000 inhabitants. In 2011, NHBD accounted for 20.19% of the kidney transplants and 19.60% of the global organ donations in the province of Granada.