A pilot study of a system for harvesting kidneys from non-heart-beating donors where attempts of resuscitation after a witnessed out-of-hospital cardiac arrest have failed (uncontrolled NHBDs) resulted in 21 successful kidney transplants - a 10% increase in the transplantation rate - over 17 months. Researchers have shown that retrieval from uncontrolled NHBDs may provide a valuable source of organs and could help counter the shortage of kidney grafts in France.
Dr Marie-Reine Losser, from the Paris Diderot University (Paris-7), worked with a team of French researchers to trial the retrieval protocol in the Hτpital Saint-Louis (Assistance Publique-Hτpitaux de Paris). She said, "Patients dying from sudden out of hospital refractory cardiac arrests may be eligible kidney donors. In the system we describe, the emergency services referred such patients to our institution under continuous ventilation and CPR. After death was certified, the kidneys were preserved while approval for donation was sought from the patient's next of kin".
Between February 1st 2007 and June 30th 2008, 122 patients were referred to the hospital in this way, and 49 were found to be eligible for organ retrieval. The families of 15 of these patients refused consent for organ donation, in 12 cases in the absence of or contrary to the donor's previously expressed wishes. From the remaining patients, 31 kidneys were transplanted and at least 27 of these transplants were ultimately successful.
According to Losser, the procedure raised ethical controversies in France, "The question emerged about a conflict of interest between patient care and potential organ procurement. In fact, in this cohort, resuscitation duration was always longer than recommended. There is, however, a clear need for better acceptance of organ donation within the population, something that could be achieved by sustained nationwide information campaigns".
- Fabienne Fieux, Marie-Reine Losser, Eric Bourgeois, Francine Bonnet, Olivier Marie, Francois Gaudez, Imad Abboud, Jean-Luc Donay, France Roussin, Francois Mourey, Frederic Adnet and Laurent Jacob. Kidney retrieval after sudden out of hospital refractory cardiac arrest: a cohort of uncontrolled non heart beating donors. Critical Care, (in press) [link]
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