Kidney and Liver Transplants from Donors after Cardiac Death: Initial Experience at the London Health Sciences Centre

Authors

Roberto Hernandez-Alejandro, The University of Western Ontario
Yves Caumartin, The University of Western Ontario
Cameron Chent, The University of Western Ontario
Mark A. Levstik, The University of Western Ontario
Douglas Quan, The University of Western Ontario
Norman Muirhead, The University of Western Ontario
Andrew A. House, The University of Western Ontario
Vivian McAlister, The University of Western Ontario
Anthony M. Jevnikar, The University of Western Ontario
Patrick P. W. Luke, The University of Western Ontario
William Wall, The University of Western Ontario

Document Type

Article

Publication Date

4-2010

Journal

Canadian Journal of Surgery

Volume

53

Issue

2

First Page

93

Last Page

102

Abstract

BACKGROUND: The disparity between the number of patients waiting for an organ transplant and availability of donor organs increases each year in Canada. Donation after cardiac death (DCD), following withdrawal of life support in patients with hopeless prognoses, is a means of addressing the shortage with the potential to increase the number of transplantable organs.

METHODS: We conducted a retrospective, single-centre chart review of organs donated after cardiac death to the Multi-Organ Transplant Program at the London Health Sciences Centre between July 2006 and December 2007. In total, 34 solid organs (24 kidneys and 10 livers) were procured from 12 DCD donors.

RESULTS: The mean age of the donors was 38 (range 18-59) years. The causes of death were craniocerebral trauma (n = 7), cerebrovascular accident (n = 4) and cerebral hypoxia (n = 1). All 10 livers were transplanted at our centre, as were 14 of the 24 kidneys; 10 kidneys were transplanted at other centres. The mean renal cold ischemia time was 6 (range 3-9.5) hours. Twelve of the 14 kidney recipients (86%) experienced delayed graft function, but all kidneys regained function. After 1-year follow-up, kidney function was good, with a mean serum creatinine level of 145 (range 107-220) micromol/L and a mean estimated creatinine clearance of 64 (range 41-96) mL/min. The mean liver cold ischemia time was 5.8 (range 5.5-8) hours. There was 1 case of primary nonfunction requiring retransplantation. The remaining 9 livers functioned well. One patient developed a biliary anastomotic stricture that resolved after endoscopic stenting. All liver recipients were alive after a mean follow-up of 11 (range 3-20) months. Since the inception of this DCD program, the number of donors referred to our centre has increased by 14%.

CONCLUSION: Our initial results compare favourably with those from the transplantation of organs procured from donors after brain death. Donation after cardiac death can be an important means of increasing the number of organs available for transplant, and its widespread implementation in Canada should be encouraged.