Presentation Authors: Jeffrey Law*, London, Canada, Karen Hornby, Clare Payne, Toronto, Canada, Alp Sener, Patrick Luke, London, Canada
Introduction: Many transplant centres utilize a hard cut off of 2 hours of warm ischemic time (WIT), defined as the time from withdrawal of life-sustaining measures to cold organ flush, to exclude donation after circulatory determination of death (DCD) kidney donation. As a result, 30% of withdrawals to retrieve DCD organs fail to produce kidney transplants in Ontario. In order to assess our ability to increase organ yield, we wanted to characterize WIT, and functional WIT (fWIT, time from systolic blood pressure < 50 mmHg to cold organ flush), as well as determine the time at which potential donors eventually die in those that did not become organ donors.
Methods: A retrospective review of all DCD kidney donors in Ontario was performed utilizing the Trillium Gift of Life Database from April 2013 to April 2018 in order to determine:1. The WIT of all DCD kidney donors in Ontario;2. The percentage of DCD kidney donors that have a 30 minute fWIT; 3. The time in which potential donors eventually die in those that did not become organ donors.
Results: Of 350 DCD kidney donors analyzed, 46.9% had < 0.5 hours, 51.7% between 0.5 - 2 hours and 1.4% >2 hours of WIT. In each of these categories (WIT < 0.5h, 0.5 - 2 hours and >2 hours), the percentage of patients with fWIT < 30min were 100%, 94.4% and 100% respectively (p = NS). There were 106 potential donors who did not end up donating due to WIT >2 hours. Of these, 20.8% died between 2-4 hours, 10.4% between 4 - 6 hours and 68.8% beyond 6 hours.
Conclusions: The percentage of donors with fWIT > 30 min did not increase with increasing WIT in DCD donors that went on to donate organs. These data support assessment of waiting up to 4 hours for DCD kidney donation as long as fWIT remains low given the shortage of available organ donors.