Donor kidneys from deceased as good as those from brain-dead: Study

By Dr. Ananya Mandal, MDAug 20 2010

According to a new study from the UK, transplanted kidneys from patients whose hearts have stopped perform just as well as those from patients who are brain-dead but still alive. The former have been earlier considered to be weaker since the heart had stopped pumping blood into them before transplant. The study was published online by the The Lancet.

Professor J. Andrew Bradley, of the University of Cambridge and his team looked at a database of 9,134 kidney transplants from 2000 to 2007. Of those, 845 were from people whose heart stopped beating after a decision to withdraw life support; the rest were from brain-dead patients. They found that both group of patients’ kidneys performed equally well at one and five years after transplantation, in terms of their survival in the body. This was seen in patients who had received transplants for the first time.

Doctors are required to wait for up to 25 minutes to declare a non-heart-beating donor legally dead. It had been thought that the loss of blood flow affected the long-term performance of kidneys but the new findings show that this is not the case. Organs from non-heart-beating donors take up to two weeks to fully assimilate with the recipient, who will require dialysis during this time.

The authors write, “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…The factors shown to affect transplant outcome for kidneys from cardiac-death donors will help to guide clinical decision making and inform future allocation policy.”

According to Dr. Jonathan S. Bromberg, a transplant specialist at the Mount Sinai Medical Center in New York City, kidneys from dead as well as brain dead individuals perform equally too. He explained that in patients whose hearts have stopped beating, it is more likely that they have certain kinds of damage and “therefore, great care must be taken to procure the organs carefully, to shorten the preservation time as much as possible, and to match the donor organs with recipients who have a decreased chance of rejecting the organs.” However, he added organs from dead donors “can result in excellent outcomes, and kidney transplantation is medically and economically superior to dialysis, so attempts to increase the organs' supply should be encouraged and supported.”

The number of UK kidney transplants could be doubled and hundreds of lives saved by using more organs from those whose hearts have stopped, experts say. These findings pave the way for reforms in transplant policy that could make an estimated 600 extra donor kidneys available to the NHS every year. The National Kidney Federation said that it hoped organs could now be sourced from willing donors who die in accident and emergency units as well as from donors in intensive care.