Kidney Donation After Cardiocirculatory Death: The Role of Extracorporeal Membrane Oxygenation
Introduction: Chronic kidney disease is a prevalent disorder, with a significant number of late stage patients, which only options are renal replacement therapy and transplantation. Kidney transplantation is associated with higher quality of life and lower mortality. The increasing gap between the demand for kidneys and its availability for transplantation has prompted the research and development of an alternative source to the conventional brain dead donors, the donors after cardiac death. The latter need preservation techniques in order to offer similar functional results. In the present article, we proposed to review the recent evidence about the role of extracorporeal membrane oxygenation as preservation technique in the harvesting of kidneys from donors after circulatory death.
Material and Methods: A literature research was conducted in PubMed/MEDLINE, using the following expressions: “kidney transplantation”; “non-heart-beating donor”; “donation after cardiac death”; “extracorporeal membrane oxygenation”; “abdominal normothermic perfusion”. Based on the selected articles, it was performed a non-systematic review, summarizing the recent evidence about the role of extracorporeal membrane oxygenation as preservation technique in the harvesting of kidneys from donors after circulatory death.
Results: The evidence suggests that extracorporeal membrane oxygenation is better than the other preservation techniques used in donors after cardiac death, as it has been associated to improved renal allograft outcomes. Regarding the conventional deceased donors, the brain dead, this technique allows similar results, particularly when compared with expanded criteria donors.
Discussion: Organ preservation through extracorporeal membrane oxygenation in cardiac death donors has favorable functional results and, for this reason, may contribute to increase the pool of donors. The logistical challenges of the technique restrict its implementation.
Conclusion: In the long-term, should be created conditions so that extracorporeal membrane oxygenation in donors after cardiac death may be widely implemented, increasing the number of kidneys obtained for transplantation.
2. Dobson R. Number of UK patients awaiting a transplant reaches record high. BMJ. 2007; 334:920-921.
3. Eurotransplant. Waiting list mortality in 2016, by country, by organ 2016. [consultado em 13-09-2017] Disponível em: http://statistics.eurotransplant.org/index.php?search_type=waiting+list.
4. Smith D. Donation after cardiac death in the intensive care unit: The role of extracorporeal membrane oxygenation. Curr Anesth Crit Care. 2010; 21:220-223.
5. A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. JAMA. 1968; 205:337-340.
6. Thuong M, Ruiz A, Evrard P, Kuiper M, Boffa C, Akhtar MZ, et al. New classification of donation after circulatory death donors definitions and terminology. Transpl Int. 2016; 29:749-59. doi: 10.1111/tri.12776.
7. Kootstra G, Daemen JH, Oomen AP. Categories of non-heart-beating donors. Transplant Proc. 1995; 27:2893-.
8. Metcalfe MS, Butterworth PC, White SA, Saunders RN, Murphy GJ, Taub N, et al. A case-control comparison of the results of renal transplantation from heart-beating and non-heart-beating donors. Transplantation. 2001;
9. Nicholson ML, Metcalfe MS, White SA, Waller JR, Doughman TM, Horsburgh T, et al. A comparison of the results of renal transplantation from non-heart-beating, conventional cadaveric, and living donors. Kidney Int.
10. British Transplantation Society and Intensive Care Unit. Donation after circulatory death 2013 [consultado em 19-10-2017] Disponível em: http://www.bts.org.uk/MBK/Clinical/Guideline/Current/Member/Clinica_guidelines.
11. Wijnen RM, Booster MH, Stubenitsky BM, de Boer J, Heineman E, Kootstra G. Outcome of transplantation of non-heart-beating donor kidneys. Lancet. 1995; 345:1067-70.
12. Minambres E, Suberviola B, Dominguez-Gil B, Rodrigo E, Ruiz-San Millan JC, Rodriguez-San Juan JC, et al. Improving the outcomes of organs obtained from controlled donation after circulatory death donors using abdominal normothermic regional perfusion. Am J Transplant. 2017; 17:2165-72. doi: 10.1111/ajt.14214.
13. Farney AC, Hines MH, al-Geizawi S, Rogers J, Stratta RJ. Lessons learned from a single center's experience with 134 donation after cardiac death donor kidney transplants. J Am Coll Surg. 2011; 212:440-51; discussion
451-3. doi: 10.1016/j.jamcollsurg.2010.12.033.
14. Wind J, Hoogland ER, van Heurn LW. Preservation techniques for donors after cardiac death kidneys. Curr Opin Organ Transplant. 2011; 16:157-61. doi: 10.1097/MOT.0b013e3283446a43.
15. Lazzeri C, Bernardo P, Sori A, Innocenti L, Stefano P, Peris A, et al. Venous- arterial extracorporeal membrane oxygenation for refractory cardiac arrest: a clinical challenge. Eur Heart J Acute Cardiovasc Care. 2013;
2:118-26. doi: 10.1177/2048872613484687.
16. Marchioro TL, Huntley RT, Waddell WR, Starzl TE. Extracorporeal Perfusion for Obtaining Postmortem Homografts. Surgery. 1963; 54:900-11.
17. Koyama I, Hoshino T, Nagashima N, Adachi H, Ueda K, Omoto R. A new approach to kidney procurement from non-heart-beating donors: core cooling on cardiopulmonary bypass. Transplant Proc. 1989; 21:1203-5.
18. Arias-Diaz J, Alvarez J, Gomez M, del Barrio R, Garcia-Carreras C, Gonzalez P, et al. Changes in adenine nucleotides and lipid hydroperoxides during normothermic cardiopulmonary bypass in a porcine model of type
II non-heart-beating donor. Transplant Proc. 1997; 29:3486-7.
19. Gonzalez FX, Garcia-Valdecasas JC, Lopez-Boado MA, Tabet J, Net M, Grande L, et al. Adenine nucleotide liver tissue concentrations from non-heart-beating donor pigs and organ viability after liver transplantation.
Transplant Proc. 1997; 29:3480-1.
20. Tabet J, Garcia-Valdecasas JC, Net M, Cifuentes A, Gonzalez FX, Valero R, et al. Evaluation of ischemic liver injury during graft procurement from non-heart-beating donor pigs. Transplant Proc. 1997; 29:3482-3.
21. Valero R, Garcia-Valdecasas JC, Tabet J, Taura P, Rull R, Beltran J, et al. Hepatic blood flow and oxygen extraction ratio during normothermic recirculation and total body cooling as viability predictors in non-heart-beating donor pigs. Transplantation. 1998; 66:170-6.
22. Barrou B, Billault C, Nicolas-Robin A. The use of extracorporeal membranous oxygenation in donors after cardiac death. Curr Opin Organ Transplant. 2013; 18:148-53. doi: 10.1097/MOT.0b013e32835e29f5.
23. Lazzeri C, Bonizzoli M, Valente S, Cianchi G, Migliaccio ML, Gensini GF, et al. The role of extracorporeal membrane oxygenation in donation after circulatory death. Minerva Anestesiol. 2014; 80:1217-27.
24. Instituto Português do Sangue e da Transplantação IP. 01-10-2014. Operacionalização do programa de colheita de órgãos em dadores em paragem cardiocirculatória. Lisboa: IPST; 2014.
25. Maleck WH, Piper SN, Triem J, Boldt J, Zittel FU. Unexpected return of spontaneous circulation after cessation of resuscitation (Lazarus phenomenon). Resuscitation. 1998; 39:125-8.
26. Ortega-Deballon I, Hornby L, Shemie SD. Protocols for uncontrolled donation after circulatory death: a systematic review of international guidelines, practices and transplant outcomes. Crit Care. 2015; 19:268. doi: 10.1186/s13054-015-0985-7.
27. Squifflet JP. Why did it take so long to start a non-heart-beating donor program in Belgium? Acta Chir Belg. 2006; 106:485-488.
28. Ugur ZB. Does presumed consent save lives? evidence from Europe. Health Econ. 2015; 24:1560-72.
29. Ministério da Saúde. DESPACHO conjunto nº 9063/2017 D.R. Série nº198 (17-10-13)
30. Shapey IM, Muiesan P. Regional perfusion by extracorporeal membrane oxygenation of abdominal organs from donors after circulatory death: a systematic review. Liver Transpl. 2013; 19:1292-303. doi: 10.1002/
31. Department of health. Legal issues relevant to non-heart beating organ donation 2009 [consultado em 08-12-2017] Disponível em: http://bts.org.uk/wp-content/uploads/2016/09/Legal-issues-relevant-to-non-heartbeating-
32. Blackstock MJ, Ray DC. Organ donation after circulatory death: an update. Eur J Emerg Med. 2014; 21:324-9. doi: 10.1097/MEJ.0000000000000082.
33. Oniscu GC, Randle LV, Muiesan P, Butler AJ, Currie IS, Perera MT, et al. In situ normothermic regional perfusion for controlled donation after circulatory death--the United Kingdom experience. Am J Transplant. 2014;
14:2846-54. doi: 10.1111/ajt.12927.
34. Magliocca JF MJ, Rowe SA, Gravel MT, Chenault RH, Merion RM, et al. . Extracorporeal support for organ donation after cardiac death effectively expands the donor pool. J Trauma. 2005; 58:1095-1101.
35. Rojas-Pena A, Reoma JL, Krause E, Boothman EL, Padiyar NP, Cook KE, et al. Extracorporeal support: improves donor renal graft function after cardiac death. Am J Transplant. 2010; 10:1365-74. doi: 10.1111/j.1600-6143.2010.03063.x.
36. Rojas-Pena A, Sall LE, Gravel MT, Cooley EG, Pelletier SJ, Bartlett RH, et al. Donation after circulatory determination of death: the university of Michigan experience with extracorporeal support. Transplantation. 2014; 98:328-34. doi: 10.1097/TP.0000000000000070.
37. Vogel T, Brockmann JG, Friend PJ. Ex-vivo normothermic liver perfusion: an update. Curr Opin Organ Transplant. 2010; 15:167-72. doi: 10.1097/MOT.0b013e328337349d.
38. Dominguez-Gil B, Haase-Kromwijk B, Van Leiden H, Neuberger J, Coene L, Morel P, et al. Current situation of donation after circulatory death in European countries. Transpl Int. 2011; 24:676-86. doi: 10.1111/j.1432-2277.2011.01257.x.
39. Gravel MT, Arenas JD, Chenault R, 2nd, Magee JC, Rudich S, Maraschio M, et al. Kidney transplantation from organ donors following cardiopulmonary death using extracorporeal membrane oxygenation support. Ann
Transplant. 2004; 9:57-8.
40. Demiselle J, Augusto JF, Videcoq M, Legeard E, Dube L, Templier F, et al. Transplantation of kidneys from uncontrolled donation after circulatory determination of death: comparison with brain death donors with or without extended criteria and impact of normothermic regional perfusion. Transpl Int. 2016; 29:432-42. doi: 10.1111/tri.12722.
41. Tillou X, Thuret R, Doerfler A, CTAFU. Ischemia/reperfusion during normothermic perfusion. Prog Urol. 2014; 24:S51-5. doi: 10.1016/S1166-7087(14)70064-8
Copyright (c) 2019 Portuguese Association of Urology
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.