Nonheartbeating Donors

The use of non-heart-beating donors is not a new concept; in fact, it constituted the only method of organ procurement at the beginning of the era of transplantation. In the past few years the use of non-heart-beating donors has witnessed a comeback. In Japan, for social reasons, non-heart-beating donors represent, together with living-related donation, the main source of transplantable organs. In the United States its use represents an adjunctive way of increasing the number of available organs. This method has been mainly reserved for the procurement of kidneys and pancreata although an extension to the utilization of liver and lung grafts has been attempted in some centers.41 The criteria utilized in the selection of these donors are the same described above for the cadaveric donors, the difference being represented by the method of procurement and the longer warm ischemia time.42

The results in a recent report by a center with a large experience with non-heart-beating donors show kidney graft survival at 1 and 2 years of 84% and 76%, respectively and are comparable with the one obtained from heart-beating cadav-

■I eric donors 90% and 85%, respectively.43 Also, in the case of pancreas transplanta-4 tion, good results were obtained with 8 out of 11 patients reaching posttransplant ® insulin independence, when non-heart-beating donors were younger than 55 years, had only 10 minutes of warm ischemia time, and in situ perfusion with cold UW solution.44

The experience with liver procurement from a non-heart-beating donor appears to be promising. The University of Wisconsin was able to increase the number of organs transplanted by 8.6% over a 17-month period. The practice of using such donors should possibly be pursued more aggressively in view of the fact that the survival of these grafts is comparable to the ones from the marginal donors.

References

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