Longer delays in organ procurement after brain death not linked to worse graft outcomes
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A study that evaluated the impact of organ procurement timing after donor brain death found longer delays were not associated with “inferior” allograft outcomes following kidney transplantation.
Rather, researchers found a “very short” delay conferred worse graft survival.
“Transplant centers in Europe aim to minimize the time from brain death to organ procurement (procurement delay), but evidence to justify this is scarce,” Verner Eerola, of the department of transplantation and liver surgery at Helsinki University Hospital, and colleagues wrote. “In the United States, procurement times are significantly longer. Our objective was to analyze how procurement delay associates with kidney allograft outcomes.”
For the study, researchers compared outcomes related to 2,388 kidney transplantations performed in Finland (median delay in organ procurement time was 9.8 hours) and 101,474 performed in the United States (median delay, 34.8 hours). For each country, time from brain death to organ perfusion (ie, organ procurement delay) was divided into quartiles (in Finland, delays ranged from 6.5 hours in quarter one to 15.1 hours in quarter four; in the United States, delays ranged from 20.5 hours to 57.1 hours)
Results showed very short (less than 8 hours) and very long procurement delays were associated with the highest risk for delayed graft function, with the lowest risk seen with delays between 20 hours and 50 hours.
Further findings indicated longer procurement delay was associated with a lower risk for graft loss (hazard ratio = 0.90 per each hour longer).
According to Eerola and colleagues, this study suggests the “sweet spot” for organ procurement occurs 24 to 48 hours after brain death.
The researchers acknowledged that potential deterioration of the donor or loss of viable organs are common concerns surrounding longer procurement delay; however, they contended there is not enough evidence to “justify these concerns.”
They noted that it remains unclear why organ procurement delay was associated with better graft survival.
“Brain death (and its associated cytokine storm) and ischemia may be considered as ‘hits’ that affect kidney allografts negatively,” the researchers wrote. “In this two-hit theory, it could be beneficial for the kidney to recover from the first hit (brain death) before it is exposed to the second hit (ischemia). Also, protective mechanisms, such as heat-shock proteins and systemic mediators upregulated by ischemia, could play a role in allograft preservation.”
Despite this uncertainty, Eerola and colleagues emphasized the importance of the findings.
“Knowing the ideal procurement delay has great implications in transplantation logistics, work shifts, resource allocation, and, ultimately, patient and graft survival,” they wrote.
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