title: Fourteen years of experience in uncontrolled organ donation after cardio-circulatory death.
abstract: BACKGROUND
  Since 1999, a protocol for uncontrolled donation after cardio-circulatory death (DCD) has been carried out in our institution. We aimed at evaluating those 14 years of local experience.
  
  
  METHODS
  We reviewed the charts of uncontrolled donors from 1999 till 2013. Potential donors with a no-flow period less than 30 minutes were considered. Kidneys were perfused by the use of a double balloon triple lumen catheter after at least a 2-minute period of no touch. We analyzed grafts outcome and warm and cold ischemia times.
  
  
  RESULTS
  Thirty-nine procedures were initiated: 19 were aborted because of family refusal (n = 7), medical reasons (n = 7), or canulation failures (n = 5) and 20 harvesting procedures were completed. Transplantation was considered for 35 kidneys (cold storage [n = 5] and hypothermic preservation system [n = 30]). The causes of withdrawal from transplantation were mostly macroscopic lesions (poor perfusion, macroscopic parenchyma or vascular lesions, or infectious risk). We transplanted 22 kidneys locally and 3 were shipped to another Eurotransplant center. Mean donor age was 40 ± 13 years. Among the 20 donors, 13 came from the emergency unit and 7 from the intensive care unit. Mean no-flow time for out-hospital management was 8.7 ± 3.6 minutes. Mean time of cardiopulmonary resuscitation was 71 ± 46 minutes. Mean cold ischemia time was 19 ± 5 hours. Primary nonfunction and delayed graft function occurred in 1 and 12 cases (4.5% and 54%), respectively. Graft survival was 86% at 1 year. Causes of graft loss during the entire follow-up were graft rejection (n = 3), ischemically damaged kidney (n = 2), and recurrence of focal segmental glomerulosclerosis (n = 1).
  
  
  CONCLUSIONS
  In our experience, uncontrolled donors represent a valuable source of kidney grafts, with a prognosis of graft function and survival similar to the literature. To increase the number of available DCD organs, new techniques, such as the use of Normothermic ExtraCorporeal Membrane Oxygenation (NECMO), as well as improvement of recruitment of out of hospital potential donors have to be considered.
authors.affiliation: Surgery and Emergency Departments, Cliniques Universitaires Saint Luc, Brussels, Belgium. Electronic address: florence.dupriez@uclouvain.be.
authors.forename: F
authors.initials: F
authors.lastname: Dupriez
authors.affiliation: Surgery and Emergency Departments, Cliniques Universitaires Saint Luc, Brussels, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: De Pauw
authors.affiliation: Surgery and Emergency Departments, Cliniques Universitaires Saint Luc, Brussels, Belgium.
authors.forename: T
authors.initials: T
authors.lastname: Darius
authors.affiliation: Surgery and Emergency Departments, Cliniques Universitaires Saint Luc, Brussels, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Mourad
authors.affiliation: Surgery and Emergency Departments, Cliniques Universitaires Saint Luc, Brussels, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Penaloza
authors.affiliation: Surgery and Emergency Departments, Cliniques Universitaires Saint Luc, Brussels, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: Van Deynse
authors.affiliation: Surgery and Emergency Departments, Cliniques Universitaires Saint Luc, Brussels, Belgium.
authors.forename: C
authors.initials: C
authors.lastname: Baltus
authors.affiliation: Surgery and Emergency Departments, Cliniques Universitaires Saint Luc, Brussels, Belgium.
authors.forename: F
authors.initials: F
authors.lastname: Verschuren
mesh_terms: D000328:Adult; D001530:Belgium; D050377:Cold Ischemia / Q000706:statistics & numerical data; D051799:Delayed Graft Function / Q000453:epidemiology; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006323:Heart Arrest / Q000401:mortality*; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012769:Shock / Q000401:mortality*; D009927:Tissue and Organ Procurement / Q000458:organization & administration*; D052096:Warm Ischemia / Q000706:statistics & numerical data; D055815:Young Adult