The effect of machine perfusion on the arteries of porcine kidneys.

OBJECTIVES: Machine perfusion is an excellent method of assessing the viability of a kidney graft and can also potentially improve the quality of an equivocal kidney. Several authors have expressed concerns that machine perfusion can potentially damage the vessels of the kidney but until now, no studies have been performed to clarify this issue. We aimed to examine the effect of machine perfusion on the renal arteries of porcine kidneys. MATERIALS AND METHODS: Eight pairs of kidneys were removed from pigs in the abattoir. One kidney of each pair was preserved on ice for 24 hours. The other kidney from the same animal was initially stored on ice until arrival at the laboratory when it was perfused on the RM3 machine for 4 hours and then stored again on ice for the remainder of the 24 hours. After 24 hours, since the retrieval and initial storage on ice at the abattoir, tissue samples were obtained from all renal arteries at 3 different sites. These samples were sent for histologic evaluation. RESULTS: Machine perfusion caused more damage at a statistically significant level compared with simple cold storage only for the first sample site, which was the part of the renal artery closest to the perfusion cannula. CONCLUSIONS: Our experiments suggest that machine perfusion, even when it is done lege artis, can damage the part of the renal artery closest to the adaptor, which can potentially result in a higher incidence of posttransplant arterial thrombosis. Therefore, excision of the first part of the renal artery should be considered prior to transplantation, and modifications of the perfusion technique must be developed to minimize damage to the renal arteries.

Ethical issues in non-heart-beating donation.

A shortage of organ donors and the large number of patients desperately waiting for kidney transplant have led to the search for new sources of transplantable organs. The waiting list has grown at an alarming rate resulting in increased waiting times and deaths. The introduction of non heart beating (NHB) donation programmes generates a lot of ethical issues. How should death of a patient be defined in the case of NHB donation? Is there a strict separation of responsibilities of the medical teams in the different phases of the procedure (patient treatment and actual donation)? How should consent be obtained? Is sufficient respect and care given to the patient and his family? How is the viability of the organs assessed and how should the organs be allocated? We believe that it is very important to debate these issues and to try to outline an ethical framework for NHB donation that can enjoy the widest possible community support.