Dynamic perfusion reconditioning of kidneys from uncontrolled DCD: early experiences from Gothenburg
Kristin PerssonAbstract
Introduction
Sweden continues to experience an organ shortage despite implementation of c-DCD. One potential way to increase organs availability, particularly kidneys is uncontrolled DCD (u-DCD), an option previously limited by warm ischemia time as well as logistical and legal considerations. We describe the early evaluation of a process aiming at recovering organs following an extended asystole (up to 4.5 h) using a novel approach combining early donor identification, rapid retrieval and perfusion reconditioning.
Methods
We identified adult patients with cardiac arrest (CA) outside hospital, with CPR performed by healthcare personnel within 15min of CA. Consent was obtained by the lead emergency physician and donation specialized staff 30-min after death declaration. The families were informed about the experimental setting and the anonymized data use. Kidneys were procured and perfused in a customized device.
Results
Five potential u-DCD were identified (age 22–75 years) and consent was obtained in three. Warm ischemia time was 408 min and CPR time 65 min. Organ retrieval and start of reconditioning was initiated within 331 min from death. Kidney perfusion/reconditioning protocol involved temperature and pressure regulation, thrombolytic agents, erythrocyte supplementation, and continuous monitoring of vascular resistance and flow. Graft reconditioning was conducted for 6,5 h. Evaluation of the kidney was performed using a four-point scale, evaluating vascular resistance. Despite that all three donors were extended criteria donors, three out of six perfused kidneys reached acceptable quality after reconditioning.
Discussion
Reconditioning u-DCD kidneys may increase donor pool and deserves further development.