Longer wait from treatment withdrawal to circulatory death may increase organ availability
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Key takeaways:
- A minimum 3-hour wait time resulted in a 14.1% increase in kidney donations compared with shorter intervals.
- Donor time to death did affect recipient outcomes.
Extending the wait time between life-sustaining treatment withdrawal and circulatory death to 3 hours may boost the number of available deceased-donor kidneys for transplantation, data show.
“For patients with end-stage kidney disease undergoing dialysis, a kidney transplant offers advantages in survival, quality of life and health care costs,” Samuel J. Tingle, MBBS, of the National Institute of Health and Care Research Blood and Transplant Research Unit at Newcastle University and Cambridge University, wrote with colleagues. “However, as the global prevalence of chronic kidney disease increases, transplant waiting times continue to lengthen, with only one-fourth of the individuals listed for transplant in the U.S. receiving a deceased-donor kidney within 5 years. Strategies that either expand the deceased-donor pool or improve use of organs from existing donors are thus required.”
Researchers conducted a population-based cohort study with 7,183 adults in the United Kingdom who had kidney-alone transplants from donors post-circulatory death between 2013 and 2021. The aim was to determine whether prolonged donor time to death after ceasing life-sustaining treatment was associated with kidney transplant outcomes.
Researchers used data from the U.K. Transplant Registry, including all 23 kidney centers.
Overall, the study included 7,183 donation after circulatory death kidney transplant recipients, of which median age was 56 years and 65% of patients were men.
For the donors, median age was 55 years. Overall follow-up lasted through 2023.
Main outcome was 12-month eGFR.
Researchers found median donor time to death was 15 minutes. Overall, 885 kidneys were transplanted from donors with a donor time to death greater than 1 hour, and 303 kidneys came from donors with donor time to death longer than 2 hours.
The 3-hour minimum wait time resulted in a 14.1% increase in donation after circulatory death kidney transplants, according to the researchers. In addition, donor time to death after withdrawal of life-sustaining treatment did not affect short- or long-term transplant outcomes, including 12-month eGFR, delayed graft function or graft survival. No major associations were found between donor time to death and outcomes. Meanwhile, ischemic times, such as cold ischemic time and donor asystolic time, were independently tied to outcomes.
“We show that meaningful increases to transplant numbers can be safely achieved by organizations that currently implement more conservative maximum wait times,” the researchers wrote. “We also suggest that 3 hours should not be used as a hard cutoff, and prolonging wait time beyond 3 hours should be a balance between organ donation organizations logistics and the likelihood of proceeding.”
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