title: Do we need a different organ allocation system for kidney transplants using donors after circulatory death?
abstract: BACKGROUND
  There is no national policy for allocation of kidneys from Donation after circulatory death (DCD) donors in the UK. Allocation is geographical and based on individual/regional centre policies. We have evaluated the short term outcomes of paired kidneys from DCD donors subject to this allocation policy.
  
  
  METHODS
  Retrospective analysis of paired renal transplants from DCD's from 2002 to 2010 in London. Cold ischemia time (CIT), recipient risk factors, delayed graft function (DGF), 3 and 12 month creatinine) were compared.
  
  
  RESULTS
  Complete data was available on 129 paired kidneys.115 pairs were transplanted in the same centre and 14 pairs transplanted in different centres. There was a significant increase in CIT in kidneys transplanted second when both kidneys were accepted by the same centre (15.5 ± 4.1 vs 20.5 ± 5.8 hrs p<0.0001 and at different centres (15.8 ± 5.3 vs. 25.2 ± 5.5 hrs p=0.0008). DGF rates were increased in the second implant following sequential transplantation (p=0.05).
  
  
  CONCLUSIONS
  Paired study sequential transplantation of kidneys from DCD donors results in a significant increase in CIT for the second kidney, with an increased risk of DGF. Sequential transplantation from a DCD donor should be avoided either by the availability of resources to undertake simultaneous procedures or the allocation of kidneys to 2 separate centres.
authors.affiliation: UCL Centre for Nephrology, Royal Free hospital, London, UK. shanka.benaragama@nhs.net.
authors.forename: Shanka K
authors.initials: SK
authors.lastname: Benaragama
authors.forename: Teressa
authors.initials: T
authors.lastname: Tymkewycz
authors.forename: Biku J
authors.initials: BJ
authors.lastname: John
authors.forename: Andrew
authors.initials: A
authors.lastname: Davenport
authors.forename: Ben
authors.initials: B
authors.lastname: Lindsey
authors.forename: David
authors.initials: D
authors.lastname: Nicol
authors.forename: Jonathon
authors.initials: J
authors.lastname: Olsburgh
authors.forename: Martin
authors.initials: M
authors.lastname: Drage
authors.forename: Nizam
authors.initials: N
authors.lastname: Mamode
authors.forename: Francis
authors.initials: F
authors.lastname: Calder
authors.forename: John
authors.initials: J
authors.lastname: Taylor
authors.forename: Geoff
authors.initials: G
authors.lastname: Koffman
authors.forename: Nicos
authors.initials: N
authors.lastname: Kessaris
authors.forename: Mohamed
authors.initials: M
authors.lastname: Morsy
authors.forename: Roberto
authors.initials: R
authors.lastname: Cacciola
authors.forename: Carmelo
authors.initials: C
authors.lastname: Puliatti
authors.forename: Susana
authors.initials: S
authors.lastname: Fernadez-Diaz
authors.forename: Asim
authors.initials: A
authors.lastname: Syed
authors.forename: Nadey
authors.initials: N
authors.lastname: Hakim
authors.forename: Vassilios
authors.initials: V
authors.lastname: Papalois
authors.forename: Bimbi S
authors.initials: BS
authors.lastname: Fernando
mesh_terms: D000328:Adult; D050377:Cold Ischemia / Q000706:statistics & numerical data*; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D015276:Health Care Rationing / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000601:surgery*; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D014015:Tissue Banks / Q000706:statistics & numerical data*; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement / Q000379:methods / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult