Kidney Transplantation from Donors without a Heartbeat

• Published in: The New England journal of medicine Vol. 347; no. 4; pp. 248 - 255
• Main Authors: Weber, Markus, Dindo, Daniel, Demartines, Nicholas, Ambühl, Patrice M, Clavien, Pierre-Alain
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 25-07-2002
• Subjects: Adult; Analysis of Variance; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Bioethics; Biological and medical sciences; Bone marrow, stem cells transplantation. Graft versus host reaction; Brain Death; Cadaver; Consent; Female; Follow-Up Studies; Graft Survival; Heart Arrest; Humans; Kidney Transplantation; Male; Medical sciences; Middle Aged; Outcome Assessment (Health Care); Patients; Risk Factors; Survival Analysis; Tissue Donors; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplants & implants; Switzerland; Europe; Human; Graft(material); Renal function; Prognosis; Antibody; Living donor; Recipient; Homotransplantation; Survival; Kidney; Rejection; Host versus graft disease; Non heart-beating donor; Graft; Comparative study; Empirical Approach; Professional Patient Relationship; Health Care and Public Health
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa020274

The shortage of renal allografts has led to interest in sources of organs other than living donors and cadaveric donors with a heartbeat. Accumulating data suggest that the short-term survival of cadaveric kidneys from donors without a heartbeat is similar to that of kidneys from donors with a heartbeat. This report describes a single-center study of 122 patients who received kidney transplants from donors without a heartbeat and 122 matched patients who received transplants from donors with a heartbeat. Recipients were followed for up to 15 years. Although there was a significantly higher incidence of initial delay in graft function among those who received kidneys from donors without a heartbeat, long-term graft survival was similar in the two groups.
In 122 patients long-term graft survival was similar to that in matched controls.
The number of patients awaiting organs for transplantation has grown dramatically during the past two decades, triggering interest in expanding the pool of organs beyond those obtained from brain-dead donors with a heartbeat. Alternative sources of organs include elderly, brain-dead donors whose hearts continue to beat, living donors, and donors without a heartbeat. A successful program of transplantation from donors without a heartbeat could increase the number of kidneys available for transplantation by 30 percent.
1
Death in donors without a heartbeat is defined as an irreversible cessation of circulatory and respiratory function,
2
whereas brain death in donors with a heartbeat . . .