Donation after Circulatory Death vs. Donors Neurologically Brain Dead: Do Transplant Outcomes Differ?
Gill, J., Rose, C., Lesage, J., Joffres, Y., Giolll, J., & O'Connor, K. (2017). Use and outcomes of kidneys from donation after circulatory death donors in the United States. Journal of the American Society of Nephrology. [Epub ahead of print.] doi:10.1681/ASN.2017030238
Organ Procurement and Transplantation Network. (n.d.). Kidney Donor Profile Index (KDPI) Guide for clinicians. Retrieved from https://optn.trans plant.hrsa.gov/resources/guidance/kidneydonor-profile-index-kdpi-guide-for-dinicians
The need for donated kidneys for transplantation is great, and the current supply does not meet the demand. Gill et al. (2017) recognized a donor source for kidneys that may be underutilized--"donation after circulatory death," or DCD. DCD donor kidneys undergo the risk of warm ischemia because the kidneys remain in the deceased donor after cardiac arrest and the organs experience ischemia in the absence of perfusion, referred to as warm ischemia time (WIT). The authors define WIT as "time from withdrawal of life-sustaining therapy (WLST) to the initiation of cold perfusion" (Gill et al., 2017, p. 2). This is in contrast to donors determined to be neurologically brain dead (NBD) while cardiopulmonary function and perfusion are supported, thus maintaining renal perfusion during organ procurement. The authors note that in 2013, 13.6% of deceased donors in the United States were identified as DCD, compared to the United Kingdom, where 40% of donors were DCD. They also explored differences in donor service areas throughout the United States.
Gill et al. (2017) offer an in-depth exploration of multiple factors that include the Kidney Donor Profile Index (KDPI) as implemented by the Organ Procurement Transplantation Network (OPTN, n.d.) that combines several risk factors of the donor that project the likelihood of graft failure. (Refer to the OPTN reference for further discussion of KDPI.) Other factors considered include ages of both donor and recipient and their comorbidities, donor characteristics that included warm and cold ischemia times (CIT)--the length of time the organ is perfused with a cold preservation solution until implantation and re-establishment of vascular flow, and the donor service area. There were marked differences among the donor service area that the authors suggest need further investigation to discern the differences.
Kidneys from NBD donors had a lower discard rate than DCD kidneys. Gill et al. (2017) found a modest increase in transplant failure when the WIT exceeded 48 minutes that was minimized when the CIT was less than 12 hours. The authors report that the recipients of DCD kidneys had an overall five-year survival of 75%, even among donors who had more than 48 minutes of WIT. They suggest a change in national data collection to explore future strategies to increase DCD kidney donation.
Karen C. Robbins, Department Editor
Karen C. Robbins, MS, RN, CNN, is the Associate Editor of the Nephrology Nursing Journal, Past-President of ANNA, and member of ANNA's Desert Vista Chapter.
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|Title Annotation:||NNJ Journal Club: Read It, Share It|
|Author:||Robbins, Karen C.|
|Publication:||Nephrology Nursing Journal|
|Date:||Nov 1, 2017|
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