196 Literature Review Led by prominent transplant surgeons Belzer, Starzl, and Van Der Linden, many procurement pro- grams have included NHBC donors in their donor pools for many years. 4-9,11 Studies done by the University Hospital of Maastricht 4 and the University of Barcelona 9 have shown that organs from NHBC donors have long- and short-term survival rates com- parable to those of organs from brain-dead donors. Innovations in surgical technique such as the rapid en bloc retrieval used at the University of Wisconsin 5 and the use of femoral cannulation for hypothermic flush- ing 7 have minimized the damage caused by increased warm ischemic time in NHBC donors. Despite the successful results achieved with this type of donor, 11 resistance persists among some in the medical community. Even some in the field of organ procurement are reluctant to include NHBC donors among their routine organ donors, especially uncon- trolled NHBC donors. 5 Methods All patients who met the following criteria were considered potential NHBC donors: 1. Donor must be legally dead before organ pro- curement. Twelve years’ experience with non–heart-beating cadaveric donors From 1983 to August 1995, the University of Miami Organ Procurement Organization evaluated 41 candidates for non–heart-beating cadaveric donation and determined that 34 patients met the criteria. All patients had irreversible brain injury incompatible with survival. All families gave permission for withdrawal of life support and for tissue and organ donation after cardiac arrest. Thirteen donors died in the operating room, and 9 died in the ICU or emergency department. Four of the 9 patients who died in the ICU had undergone femoral cannulation. The remaining 12 donors were brain-dead but had an unpredicted cardiac arrest before laparotomy. All kidneys were preserved by using machine pulsatile perfusion, and 21 kidneys were transported to other centers. Of the 35 transplanted kidneys, 26 (74%) had immediate function, 6 (17%) had delayed graft function, and 3 (9%) were not used for other reasons. Five of the six transplanted livers had immediate function. (Journal of Transplant Coordination. 1996;6:196-199) L Olson, BA, V L Castro, MD, G Ciancio, MD, G Burke, MD, J Nery, MD, L B Cravero, RN, A Tzakis, MD, J Miller, MD University of Miami School of Medicine, Miami, Fla, and Broward General Hospital, Fort Lauderdale, Fla (VLC) Reprint requests: Innovision Communications 101 Columbia, Aliso Viejo, CA 92656 Phone (800) 899-1712 (ext 532) or (714) 362-2050 (ext 532) Fax (714) 362-2022 E-mail ivcReprint@aol.com Journal of Transplant Coordination, Vol. 6, Number 4, December 1996 S ince the advent of successful organ transplanta- tion, one of the major difficulties in treating end- stage organ failure has been the shortage of organs to transplant. With the availability of long-term hemodialysis, 31,022 patients are now waiting for kidney transplants. 1 Despite a major effort to educate the medical community and the public, the number of organ donors has stabilized or declined relative to the number of patients waiting for organs. 2,3 To increase the number of organs available for transplantation, many organ procurement organizations and transplant centers have liberalized their criteria for donors, accepting older donors, patients with questionable social or medical histories or certain positive results on serological tests, and non–heart-beating cadaveric (NHBC) donors. 4-11 The NHBC donors can be categorized in two groups: controlled and uncontrolled donors. Controlled donors are terminal patients, in whom death can be predicted (ie, patients in the ICU who are terminal and whose life support is withdrawn). Uncontrolled donors are those patients who die unexpectedly (ie, patients who die just before or after arrival at the hospital). Between 1983 and August 1995, our center performed nephrectomies and hepatectomies on 23 controlled NHBC donors and 11 uncontrolled NHBC donors.