title: Does DCD Donor Time-to-Death Affect Recipient Outcomes? Implications of Time-to-Death at a High-Volume Center in the United States.
abstract: For donation after circulatory death (DCD), many centers allow 1 h after treatment withdrawal to donor death for kidneys. Our center has consistently allowed 2 h. We hypothesized that waiting longer would be associated with worse outcome. A single-center, retrospective analysis of DCD kidneys transplanted between 2008 and 2013 as well as a nationwide survey of organ procurement organization DCD practices were conducted. We identified 296 DCD kidneys, of which 247 (83.4%) were transplanted and 49 (16.6%) were discarded. Of the 247 recipients, 225 (group 1; 91.1%) received kidneys with a time to death (TTD) of 0-1 h; 22 (group 2; 8.9%) received grafts with a TTD of 1-2 h. Five-year patient survival was 88.8% for group 1, and 83.9% for group 2 (p = 0.667); Graft survival was also similar, with 5-year survival of 74.1% for group 1, and 83.9% for group 2 (p = 0.507). The delayed graft function rate was the same in both groups (50.2% vs. 50.0%, p = 0.984). TTD was not predictive of graft failure. Nationally, the average maximum wait-time for DCD kidneys was 77.2 min. By waiting 2 h for DCD kidneys, we performed 9.8% more transplants without worse outcomes. Nationally, this practice would allow for hundreds of additional kidney transplants, annually.
authors.affiliation: Division of Transplantation, Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: J R
authors.initials: JR
authors.lastname: Scalea
authors.affiliation: Division of Transplantation, Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: R R
authors.initials: RR
authors.lastname: Redfield
authors.affiliation: Division of Transplantation, Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: E
authors.initials: E
authors.lastname: Arpali
authors.affiliation: Division of Transplantation, Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: G E
authors.initials: GE
authors.lastname: Leverson
authors.affiliation: University of Wisconsin Organ and Tissue Donation, Madison, WI.
authors.forename: R J
authors.initials: RJ
authors.lastname: Bennett
authors.affiliation: University of Wisconsin Organ and Tissue Donation, Madison, WI.
authors.forename: M E
authors.initials: ME
authors.lastname: Anderson
authors.affiliation: Division of Transplantation, Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: D B
authors.initials: DB
authors.lastname: Kaufman
authors.affiliation: Division of Transplantation, Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: L A
authors.initials: LA
authors.lastname: Fernandez
authors.affiliation: Division of Transplantation, Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: A M
authors.initials: AM
authors.lastname: D'Alessandro
authors.affiliation: Division of Transplantation, Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: D P
authors.initials: DP
authors.lastname: Foley
authors.affiliation: Division of Transplantation, Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: J D
authors.initials: JD
authors.lastname: Mezrich
mesh_terms: D000328:Adult; D001926:Brain Death; D046148:Donor Selection; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival; D006323:Heart Arrest; D061847:Hospitals, High-Volume; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement / Q000379:methods* / Q000706:statistics & numerical data; D014481:United States
keywords: clinical research/practice; donors and donation: deceased; donors and donation: donation after circulatory death (DCD); health services and outcomes research; kidney transplantation/nephrology; organ allocation; organ procurement; organ procurement and allocation; organ procurement organization