Status:
Ready to upload
Record number:
1675
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
In this study, damage to a kidney resulting in a non-transplantable organ was rare ( 0.8%). A total of 13,260 kidney procurements were performed in the United Kingdom over a 10-year period (2000–2010). Injuries to the kidney occurred in 903 procedures (7.1%) but not all injuries result in discard. Procurement from DCD (donation after circulatory death) donors leads to higher rates of injury to the kidney and are more likely to be discarded.
Time to detection:
Immediately upon procurement of kidneys.
Alerting signals, symptoms, evidence of occurrence:
Injuries occurred in 903 procedures (7.1%). Capsular, ureteric and vascular injuries occurred in 1.7%, 0.7% and 4.8% procurements, respectively. Rates of kidney injury were significantly higher when recovered from DCD donors (11.4% vs. 6.8%, p < 0.001). Univariate analysis suggests that donor age, high BMI, male gender and DCD donor type were significantly associated with a higher rate of injury. Not retrieving the liver at the donor operation was also associated with increased kidney damage.
Demonstration of imputability or root cause:
Due to a desire to minimize both warm and cold ischaemia during recovery, less dissection and more rapid removal occurs. This combination makes procurement from DCD donors a more challenging operation. DCD donation is associated with a significantly increased incidence of procurement related kidney damage, especially with regard to ureteric and polar artery injuries. The awareness of this issue should lead to an optimization of procurement techniques.
Groups audience:
Suggest new keywords:
organ procurement, kidney, damage, injury, DCD
Reference attachment:
Suggest references:
Ausania, F., White, S., A., Pocock, R. and Manas, D. M. 2012. Kidney damage during organ recovery in donation after circulatory death donors: data from UK National Transplant Database. American Journal of Transplantation 12: 932-936
Expert comments for publication:
This is a detailed, 10-year long retrospective study and report by NHS Blood and Transplant (NHSBT). Similar studies and outcomes from other transplant programs would serve to better understand frequency and reasons for damage to kidneys at procurement.