Non-heart-beating Cadaver Donors

Worldwide the still increasing number of renal patients on the waiting list for a kidney transplantation is in glaring contrast with the number of kidneys available. The number of kidneys procured in the Western world reached a plateau in the early 1990s, with no marked increase since then. Within the Eurotransplant (ET) area, compared to 1996, the number of donors remained the same in 1997 (3109 versus 3119 respectively), whereas the number of patients on the waiting list increased by 4% (12 224 versus 12 728 respectively) [1]. Given the organ shortage the international transplantation community has started a search for alternative donor sources. Both living related and living unrelated kidney donation provide excellent transplant results, the latter not being less favorable compared to living related results [2,3]. In some countries, such as Norway, almost 40% (1996) of all transplants performed are from living donors, keeping the average waiting time for a transplant between 4 and 10 months [4]. In the USA (28%), Canada (28%) and Australia (24%) living donation comprises about a quarter of all kidney transplants [5]. However, UNOS (United Network for Organ Sharing) data show that the waiting list for a kidney transplant is still increasing, suggesting that alternatives need to be investigated. Extensive research on expanding the donor criteria is being performed and debated on. In Europe initiatives such as “Donor Action”, “Don Quichot” and the “EDHEP (European Donor Hospital Education Program) course” are being developed, helping medical health care professionals to recognize suitable donors and showing them how to approach the donor family. Over all, utilization of the so-called non-ideal donor, i.e. older donors, or for instance brain-dead donors with prolonged hypotension, mild hypertension or diabetes, is thought to be acceptable in expanding the donor pool [6,7]. However, there is a growing belief that only the implementation of non-heart-beating (NHB) donor programs on a broad scale will have the potential not only to preventing the waiting list growing, but also to decrease the number of patients on the waiting list [8]. For this reason an increasing number of transplant centers, in both Europe and the USA, have (re)started using this donor source, which is not a new concept.