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Kidney donor supply could receive large boost

Cardiac death donors allow effective transplants

Adrian O'Dowd

Thursday, 19 August 2010

The number of people able to receive a kidney transplant in the UK could increase significantly following the findings of a new study published online today in The Lancet.

Researchers found that kidneys from cardiac-death patients performed just as well as those from brain-dead patients and could now provide a valuable additional source of donor organs.

Numbers of people on the kidney transplant waiting list in the UK continue to increase with over 7,000 patients currently waiting for transplant and only 1,600 kidney transplants performed from deceased donors each year.

Until recently, most donated kidneys came from donors who were brain dead, but the number of these donors has fallen over the last decade due to improvements in the treatment of head injuries and a reduction in road deaths.

Consequently, there has been a corresponding surge in the number of cardiac-death donors, rising from 3% of all donations in 2000 to 32% in 2009. Cardiac-death donor kidneys, however, fall outside of the UK’s national allocation policy and are only distributed locally.

Concerns have been raised that kidneys transplanted from cardiac death donors do not perform as well as those from brain-dead donors, which prompted The Lancet study.

In the study, Professor Andrew Bradley of University of Cambridge and Addenbrooke’s Hospital, Cambridge, and colleagues looked at outcomes for kidneys after controlled cardiac death versus brain death, and aimed to identify factors affecting graft survival and function.

They used data from the UK transplant registry to select a cohort of deceased kidney donors and the corresponding transplant recipients (aged 18 and over) for transplants done between Jan 1, 2000, and Dec 31, 2007.

During that period, a total of 9,134 kidney transplants were done in 23 centres; 8,289 kidneys were donated after brain death and 845 after controlled cardiac death.

There was no difference between the two groups in graft survival up to five years or in kidney function (filtration rate) at one to five years after transplantation.

The authors said: “The shortage of donor organs remains one of the key challenges faced by the international transplant community.

“In view of our findings, cardiac-death donors represent an extremely important and overlooked source of high-quality donor kidneys for transplantation and have the potential to increase markedly the number of kidney transplants performed in the UK.”

They believed that cardiac-death donor kidneys, which fall outside of the UK’s national allocation policy, should now be treated in the same way as kidneys from brain-dead donors.

They concluded: “Kidneys from controlled cardiac-death donors provide a good outcome in terms of both graft survival and graft function in first-time recipients and should be regarded as equivalent to kidneys from brain-death donors.”

In an accompanying comment, Professor Sir Peter Morris of the Centre for Evidence in Transplantation, Royal College of Surgeons of England and London School of Hygiene and Tropical Medicine, says: “Today’s report is an important contribution to the problem of increasing the supply of donor kidneys for transplantation.

“The results are persuasive that the use of controlled cardiac-death donors is an acceptable practice. More importantly, potential recipients of kidneys from cardiac-death donors can be reassured that their transplant outcome is not jeopardised by the source of the kidney.”


DOI:10.1016/S0140-6736(10)60827-6
DOI:10.1016/S0140-6736(10)61078-1

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