Assessment of donors with sub-optimal kidney function/structure (original) (raw)

GUIDELINES No recommendations possible based on Level I or II evidence. Deceased Kidney Donor Suitability Guidelines S117 3. Age limit 65 years 4. No signs of IV drug use 5. No systemic infection/sepsis 6. No history of kidney disease, uncontrolled hypertension, or malignancy other than primary, non-metastasizing CNS tumours. Preservation of organs should take place soon after the declaration of death to limit ischaemic damage. When death is declared on cardiac criteria, a period of non-action is observed before commencing mechanical resuscitation and preservation of the kidneys by in-situ cooling. There is variation between units in how this is performed. 4 Categories of NHB donors (Maastricht) The common situation is that all NHB donors have sustained irreversible cardiac arrest. Category 1: 'Dead-on-arrival' at hospital-cause of death is obvious (e.g. serious head injury) and no resuscitation is given. This is an unusual event and rare source of NHB donors. Category 2: 'Unsuccessful resuscitation'-an individual is brought to Accident & Emergency while being resuscitated but this is not effective or arrest occurs on the hospital ward and they are unable to be resuscitated. These are relatively common events and represent the largest potential pool of NHB donors. Category 3: 'Awaiting cardiac arrest'-e.g. severe brain damage without brain death has occurred. Patients are mostly ventilator-dependent and after consent from relatives, the ventilator is switched off and cardiac arrest awaited. The agonal period is limited to 2 hours to avoid damage from hypotension and hypoxia. Category 4: 'Cardiac arrest while brain dead'-these patients are in the process of being diagnosed brain dead and do not respond to cardiopulmonary resuscitation. SEARCH STRATEGY Databases searched: MeSH terms and text words for kidney transplantation and cadaveric organs were combined with MeSH terms and text words for diabetes, hypertension, viruses, bacterial infections, non-heart beating, marginal donor, paediatric donor, aged donor, and donor with prior cancer. These were then combined with the Cochrane highly sensitive search strategy for randomised controlled trials and search filters for identifying prognosis and aetiology studies. The search was carried out in Medline (1966-November Week 2 2003). The Cochrane Renal Group Trials Register was also searched for trials not indexed in Medline. Date of searches: 12 December 2003. WHAT IS THE EVIDENCE? There are no randomised controlled trials for this subject and they would be difficult to perform. The information comes from individual centre reports and Registry reports and the numbers are small.