ABSTRACT
INTRODUCTION: Cold ischemia time (CIT) influences long-term graft survival after deceased donor (DD) kidney transplantation. The aim of the present study was to identify factors that influenced CIT at our institution, seeking to lay ground for improvement. PATIENTS AND METHODS: Patients who underwent DD kidney transplantations from November 2008 to April 2009 were included in the study. In a prospective protocol the times for various events were registered. The 40 DD kidney transplantations included 26 "paired" kidneys from the same donor and 14 "single" kidneys. RESULTS: The mean CIT was 15.2 hours ± 4.2 hours (range, 7.0-23.9). "First kidney" was 13.3 hours ± 3.4 versus 19.2 ± 2.8 hours for the "second kidney" (P < .001). The waiting time for the operating room (OR) was 2.4 hours (range, 0-12 hours). Twenty-five percent of the patients waited more than 4 hours. Patients arriving at the hospital at the same time as or before the kidney retrieval showed a CIT of 13.4 ± 3.9 hours compared with 17.4 ± 3.4 hours for patients that arrived after the retrieved kidney (P < .01). CONCLUSION: We identified factors influencing CIT that could lay the foundation for improvement. An extended cooperation and exchange with another transplantation unit for the "second kidney" could reduce the CIT. To reduce the waiting time for OR at the hospital to less than 2 hours and to get the recipient into the hospital before the kidney arrives are efforts that could reduce CIT.
Subject(s)
Cold Temperature , Ischemia , Kidney Transplantation , Kidney/blood supply , Humans , Sweden , Time and Motion StudiesABSTRACT
In the Swedish Västra Götaland region (1.65 million inhabitants), we have implemented, as from January 1, 2006, a new concept to improve the organ donation rate, which in 2005 was 13.9 per million population (PMP). There are two cornerstones in the project: a new, active role for the transplant coordinators and the establishment of a uniform policy for the care of potential donors as well as criteria for the decision to offer intensive care in various critical conditions. The coordinator is now contacted at an early stage and is in place when the brain death diagnosis is underway or completed. The coordinator is thereafter a resource for all aspects of the care of the potential donor/donor, and also in the contact with the relatives. To date (May 2006) the donation rate has reached 23.6 PMP annually (a 70% increase).
Subject(s)
Tissue Donors/statistics & numerical data , Tissue and Organ Procurement/methods , Adolescent , Adult , Aged , Cadaver , Cause of Death , Family , Humans , Middle Aged , Patient Selection , Sweden , Tissue and Organ Procurement/standardsSubject(s)
Liver Transplantation/physiology , Liver , Organ Preservation/methods , Portal System , Aorta , Female , Follow-Up Studies , Humans , Ischemia , Liver Function Tests , Liver Transplantation/mortality , Male , Medical Records , Middle Aged , Perfusion , Retrospective Studies , Survival Rate , Time Factors , Tissue DonorsABSTRACT
The register has been a support for the coordinators in Sweden when the relatives have said one thing and the deceased person another in regards to donation. Most of the staff are positive to the register and the safety regulations around it. Most often it has been a relief for the relatives that the deceased person's wishes also have been documented in the register or in the donor card. Most decisions are still, however, made by relatives. There is still a need for more positive information about transplantation and its value.
