Renal transplantation from non-heart- beating donors: a review of the European experience.

Shortage of organs for transplantation has prompted a few centers in Europe to retrieve kidneys from non-heart-beating donors (NHBD). Indeed, it has been suggested that NHBDs could bridge the gap between supply and demand in renal transplantation. However, NHB donation still has only limited diffusion. Reluctance to accept NHBDs as a source of kidneys is due to medical, organizational and ethical reasons. The experiences, protocols and results in Europe are described in this review. The analysis of the European experience of kidney transplantation from NHBDs looks promising in term of results. Long-term outcome is very similar in the two groups notwithstanding worse short-term results. Actually, the primary non functioning of grafts is significantly worse in NHBD kidneys. However, data suggest that results could be improved by better patient selection and retrieval team organization. Delayed graft function is also much more frequent in NHBD kidneys; this poses problems in the short-term, but in the long-term does not seem to influence the outcome. The risk that efforts in NHBD programs endanger regular HBD programs because of limited organizational resources is not supported by published data. Indeed, in the experiences analysed here it appears that NHBD consistently increased the number of available kidneys and has no effect on HB donations.