Non-heart-beating donors: Experience from the Hospital Clinico of Madrid

Non-heart-beating donors (NHBD) have received attention in the last few years as an alternative source to increase the pool of kidney donors. The majority of reports focus on NHBD from controlled donors, i.e. patients who die in hospital. This report focuses on our experience using uncontrolled NHBD, i.e. patients who die outside of hospital and are transported to hospital for organ donation. We evaluated 188 renal transplantations performed in two periods 1989-1992 and 1995-2000. As to the latter period, renal transplantations from NHBD were compared to those from 345 heart-beating donor (HBD). Graft survival at 7 years shows a better tendency in NHBD group, with no statistical significance. When patients over 60 years of age were excluded from the group of patients receiving HBD kidneys, results were the same. At 2 years renal function post-transplantation was better in NHBD organs, as evaluated by serum creatinine and creatinine clearance, while after 2 years it was similar. The incidence of acute renal rejection was lower in NHBD; however, delayed graft function, as expected, was more prevalent in NHBD, although interestingly it did not influence long-term survival. In conclusion NHBD from deaths outside the hospital may be a good source of donor kidneys and also a way to successfully increase the pool for organ transplantation.