Kidney Donation After Cardiocirculatory Death: The Role of Extracorporeal Membrane Oxygenation
Keywords:Coronary Circulation, Death, Donor Selection, Extracorporeal Membrane Oxygenation, Graft Survival, Kidney Transplantation, Organ Preservation
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.
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