title: Does national sharing of kidneys donated after cardiac death lead to poorer outcomes?
abstract: BACKGROUND
  Kidneys donated after cardiac death (DCD) represent an increasing proportion of transplant activity. There have been concerns that wider sharing of these kidneys increases the cold ischemic time (CIT) and leads to poorer outcomes.
  
  
  METHODS
  DCD kidney transplantation was implemented in Scotland in 2005, with each center transplanting locally donated kidneys. A national sharing scheme of DCD kidneys was introduced in 2007, whereby kidneys are shared between the 2 renal transplant centers in the country. A single national multiorgan retrieval team carries out retrievals and kidneys are shipped directly to the 2 units. Donor and recipient demographic data, cold ischemic time, and outcome data were prospectively collected and compared within each center and between centers pre- and postintroduction of the sharing policy.
  
  
  RESULTS
  Since 2005, 152 DCD kidney transplants have been performed. Since 2007, 68 kidneys were shared between the centers. Recipient demographics were comparable before and after the introduction for the sharing scheme. The CIT was significantly higher in Glasgow (14.30 ± 3.79 hours) compared with Edinburgh (10.72 ± 2.99 hours; P < .001, one-way analysis of variance [ANOVA] prior to the introduction of the sharing scheme. Following the implementation of kidney sharing, there was no significant difference in CIT between Glasgow and Edinburgh (10.50 ± 3.34 hours vs 10.53 ± 2.71 hours). A significant reduction in the CIT in Glasgow was noted after sharing was instituted (from 14.30 ± 3.79 hours to 10.50 ± 3.34 hours, P < .001, one-way ANOVA). Patient and graft survivals, acute rejection, and delayed graft function as well as 1-year renal function were comparable in both centers before and after the introduction of the scheme.
  
  
  CONCLUSIONS
  Wider sharing of DCD kidneys should be encouraged, as it does not compromise clinical outcomes. A transparent and well-established sharing agreement, with no delays in the offering of DCD kidneys, may lead to an improvement in CIT.
authors.affiliation: Transplant Unit, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
authors.forename: S J
authors.initials: SJ
authors.lastname: Falconer
authors.forename: L J
authors.initials: LJ
authors.lastname: Pairman
authors.forename: J
authors.initials: J
authors.lastname: Glen
authors.forename: M
authors.initials: M
authors.lastname: Clancy
authors.forename: G C
authors.initials: GC
authors.lastname: Oniscu
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D003404:Creatinine / Q000097:blood; D051799:Delayed Graft Function; D005260:Female; D006084:Graft Rejection; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012606:Scotland; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome
chemical_list: D003404:Creatinine