The Use of Non-Heart Beating Donors to Expand the Donor Pool

Jong Man Kim; Sung Joo Kim

doi:10.4285/jkstn.2010.24.3.165

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Kim and Kim: The Use of Non-Heart Beating Donors to Expand the Donor Pool

Review Article

J Korean Soc Transplant 2010;24(3):165-172.

Published online: 10 September 2010

DOI: https://doi.org/10.4285/jkstn.2010.24.3.165

The Use of Non-Heart Beating Donors to Expand the Donor Pool

Jong Man Kim, M.D., Sung Joo Kim, M.D.

¹Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

책임저자：김성주, 서울시 강남구 일원동 50번지성균관대학교 의과대학 삼성서울병원 이식외과, 135-710 Tel: 02-3410-3476, Fax: 02-3410-0040 E-mail: kmhyj111@skku.edu

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

There is a persistent shortage of allografts available for transplantation, so we envisioned using non-heart beating donation to expand the donor pool. Non-heart beating donors (NHBD) were categorized using four definitions. Controlled donors, consisting of categories III and IV, are the most suitable for NHBD. Delayed graft function is associated with the use of kidneys from such donors, but had no difference on graft survival in the long-term results compared with heart beating donors. The proportion of NHBD of deceased donors differs considerably among countries, but national programs in many nations have now been initiated to increase the rate of non-heart beating donation. In most cases, the organs from NHBD are not available for transplantation in Korea because of legal restrictions. The use of controlled NHBD is encouraged to expand available allografts in Korea, due to the shortage of such allografts

Keywords: Deceased donor, Delayed graft function, Graft survival, Maastricht classification, Non-heart beating donor, Primary non-function, Warm ischemic time

References

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Fig. 1.

The number of kidney and liver transplantation in Korea. Abbreviations: DDKT, deceased donor kidney transplantation; DDLT, deceased donor liver transplantation; LDKT, living donor kidney transplantation; LDLT, living donor liver transplantation. Adapted from reference [23].

Fig. 2.

Transplant numbers by donation type. Abbreviations: SCD, standard criteria donor; ECD, extended criteria donor; DCD, deceased cardiac death donor. Reprinted from Fig. III-3 of reference [10].

Fig. 3.

(A) Long-term outcome for deceased donor by donor type, (B) The graft survival rate by donor type. Abbreviations: NHBD, non-heart beating donor; HBD, heart beating donor; SCD, standard criteria donor; ECD, extended criteria donor; DCD, deceased cardiac death donor.

Fig. 4.

Waiting lists and the number of deceased donor in Korea. Adapted from reference [23].

Fig. 5.

The number of non-heart beating donation (NHBD) and dead donor for evaluating brain death between 2006 and 2009.

Fig. 6.

Non-heart beating donation (NHBD) at Samsung Medical Center. Abbreviation: DDKT, deceased donor kidney transplantation.

Fig. 7.

Serum creatinine levels by donor type at Samsung Medical Center (means, 95% confidence intervals) (P＜0.05). Abbreviations: SCD, standard criteria don; ECD, extended criteria donor; NHBD, non-heart beating donor.

Table 1.

Maastricht classification of non-heart beating donor

Category	Description	Procurement
I	Dead on arrival	Uncontrolled
II	Unsuccessful resuscitation	Uncontrolled
III	Awaiting cardiac arrest	Controlled
IV	Cardiac arrest while brain dead	Controlled

Adapted from Table 1 of reference [5].

Table 2.

International organ donation and transplantation

	Total	Non-heart
	deceased donors	beating donors
Australia	247	42 (17.0%)
Brazil	1,658	0
Germany	1,217	0
Italy	1,272	2 (0.1%)
Japan	105	98 (93.3%)
Spain	1,606	108 (6.7%)
Netherlands (2005)	399	189 (47.4%)
UK	931	316 (33.9%)

Adapted from reference [11].

Table 3.

Studies on non-heart beating donation and heart beating donation

Study	Donor type	PNF (%)	DGF (%)	Graft survival at 1 year (%)	Graft survival at 5 years (%)	Reference No.
Case-controlled studies
Wijnen (1995)	NHB	14	60	73	54	(24)
	HB	8	35	73	55	(24)
Metcalfe (2001)	NHB	7	73	81	73	(25)
	HB	4	15	86	65	(25)
Weber (2002)	NHB	6	48	92	84	(26)
	HB	5	24	91	83	(26)
Gok (2002)	NHB	9	86	90	–	(27)
	HB	2	39	91	–	(27)
Sudhindran (2003)	NHB	0	50	84	74	(28)
	HB	2	17	89	80	(28)
Wells (2009)	NHB	5.8	64.4	90.0	78.3	(29)
	HB	1.9	28.8	94.9	80.7	(29)
Cohort studies
Cho (1998)	NHB	4	48	83	–	(16)
	HB	1	22	86	–	(16)
Nicholson (2000)	NHB	7.0	93.5	–	79	(30)
	HB	2.7	23.7	–	75	(30)
Akoh (2009)	NHB	0	44	88	–	(21)
	HB	11.7	14	93	–	(21)

Abbreviations: PNF, primary non-function; DGF, delayed graft function; NHB, non-heart beating donation; HB, heart beating donation.

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