NEPHROLOGY 2005; 10, S116–S132 Blackwell Science, LtdOxford, UKNEPNephrology1320-53582005 Asian Pacific Society of Nephrology10S4116132 Deceased Kidney Donor Suitability GuidelinesThe CARI Guidelines Deceased Kidney Donor Suitability Guidelines DEBORAH VERRAN CONVENOR (Camperdown, New South Wales) AMANDA ROBERTSON (Parkville, Victoria) JEREMY CHAPMAN (Westmead, New South Wales) STEVEN CHADBAN (Camperdown, New South Wales) 0 Non-heart–beating donors Date written: July 2004 Final submission: April 2005 SUGGESTIONS FOR CLINICAL CARE (Suggestions are based on Level III and IV sources) • Non-Heart Beating (NHB) donors should be consid- ered as an extra source of deceased donor kidneys for transplantation, with acceptable patient and graft sur- vival, in spite of an increased incidence of delayed graft function. • Results using kidneys from NHB donors may be improved by using ‘controlled’ donors younger than 60 years of age and by minimising warm and cold ischaemic times (? use kidneys locally). • Transplant Centres are encouraged to develop proto- cols which satisfy local and regional ethical and legal requirements. • All NHB donation procedures occur as an emergency and require a team including transplant co-ordinators and surgeons available urgently 24 hours a day. BACKGROUND The objective of this guideline is to explore the option of using non-heart beating donors (NHB) for renal transplantation. NHB donors are used by a number of centres as a means of overcoming the shortage of kidneys available for trans- plantation. NHB donors can make a significant contribu- tion to transplant numbers: in Maastricht (Netherlands), 40% of transplants and in Leicester (UK) 22% of trans- plants are derived from NHB donors. However, in both cen- tres there has been no increase in the overall transplant rate and it could be argued that the effort and resources dedi- cated to these programmes has resulted in a decrease of kid- neys from other and potentially better sources. 1 NHB donors have higher rates of primary non-function compared with heart beating (HB) donors (5.8% vs 1.3%) and higher rates of delayed graft function (DGF, 42.4% vs 23.3%). 2 However, there are similar rates of acute rejection and allograft survival is not significantly different between NHB and HB donor transplants. 1,3 Patient survival is similar for NHB compared with HB recipients at 6 years. 3 The use of NHB donors raises many ethical and logisti- cal issues which must be clarified prior to commencing this programme. To avoid a negative impact on HB donor pro- grammes, it is important be clear that NHB donors are in addition to and not instead of HB donors. What category of NHB donors should be used? Potentially up to 50% of kidneys are discarded following procurement because of technical problems making them unsuitable for transplan- tation which can be difficult for donor families. Acceptance of NHB donor programmes by the community and hospital staff can be challenging. Is it acceptable to perform cannu- lation and in-situ perfusion prior to obtaining consent from the next-of-kin? In the Netherlands, this has been passed with legislation but in the UK this depends on the Coroner. 1 All NHB donation procedures occur as an emergency and it is essential to have a team including transplant co-ordinators and surgeons available 24 hours a day. This is a major consideration for the implementation of a NHB programme and a disincentive to many units. 1 Criteria for NHB donors (Maastricht) 1. Duration of circulatory arrest < 30 min without profes- sional cardiac massage and ventilation 2. Professional cardiac massage and ventilation not exceed- ing 2 hours GUIDELINES No recommendations possible based on Level I or II evidence.