DCD kidney transplantation: results and measures to improve outcome

The purpose of the present review is to describe the current kidney preservation techniques for donors after cardiac death and to give insight in new developments that may reduce warm ischemia times and therefore improve graft function after transplantation. There is still a general reluctance to use donors after cardiac death for kidney donation and transplantation, because of a relatively high incidence of delayed graft function and primary nonfunction compared to conventional donors after brain death. New clinically applicable methods, such as automated chest compression devices and extracorporeal membrane oxygenation, may reduce warm ischemia time. Kidneys from donors after cardiac death sustain an increased incidence of delayed graft function and primary nonfunction. However, transplanted kidneys that do not experience these complications survive as long as conventional kidneys from donors after brain death. Maintaining adequate organ perfusion after cardiac death by using automated chest compression devices and extracorporeal membrane oxygenation reduces warm ischemia time. Optimal organ preservation and careful selection of kidneys from donors after cardiac death may reduce the risk of delayed graft function and primary nonfunction. Major efforts should continue to be made to improve the quality of kidneys from donors after cardiac death and thereby expand the utilization of this large pool of donor kidneys to its full potential.