Successful kidney transplantation from a donation after cardiac death donor with acute renal failure and bowel infarction using extracorporeal support.
As a result of the ever widening disparity between organ supply and demand, a resurgence of interest has occurred in kidney recovery from donation after cardiac death (DCD) donors. New techniques of in situ extracorporeal support offer the potential to reduce warm ischemic injury and optimize donor management prior to organ recovery. In addition, preliminary outcomes using kidneys from selected deceased donors with rising serum creatinine levels have been promising. However, contraindications to successful organ donation and transplantation may include the presence of abdominal compartment syndrome, generalized bowel infarction, refractory shock with profound metabolic and lactic acidosis, and acute anuric renal failure, particularly in the setting of DCD. We report herein the successful recovery and transplantation of kidneys from an unstable donor with the above constellation of conditions in the setting of extracorporeal support after declaration of death by asystole.
Zuckerman
Jack M
JM
Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Singh
Rajinder P
RP
Farney
Alan C
AC
Rogers
Jeffrey
J
Hines
Michael H
MH
Stratta
Robert J
RJ
D058186:Acute Kidney Injury / Q000209:etiology; D000328:Adult; D001237:Asphyxia; D003161:Compartment Syndromes / Q000150:complications; D000075202:Contraindications; D003643:Death; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D005260:Female; D005922:Glomerulonephritis, IGA / Q000601:surgery; D006085:Graft Survival; D006801:Humans; D007238:Infarction; D007422:Intestines / Q000098:blood supply; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D013405:Suicide; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting; D009927:Tissue and Organ Procurement / Q000379:methods