Kootstra Gauke, van Heurn Ernest
University of Maastricht, Maastricht, The Netherlands.
Nat Clin Pract Nephrol. 2007 Mar;3(3):154-63. doi: 10.1038/ncpneph0426.
There is a persistent shortage of kidneys available for transplantation. In the early 1980s, therefore, we published the concept of non-heartbeating (NHB) donation; that is, procurement of kidneys from donors whose death has been accompanied by irreversible circulatory arrest. NHB donors are generally categorized using four definitions; category III (awaiting cardiac arrest) and category IV (cardiac arrest while braindead)--or 'controlled'--donors are the most suitable for initiating NHB donation programs. Delayed graft function is associated with use of kidneys from such donors, but has no effect on graft survival in the short or long term. Use of kidneys from category I (dead upon arrival at hospital) and category II (unsuccessfully resuscitated), or 'uncontrolled', donors is likewise associated with delayed graft function, but also with an increased risk of primary nonfunction. Viability testing of donated organs from these sources is a prerequisite for transplantation. Machine preservation parameters and enzyme release measurements help to distinguish viable from nonviable kidneys. The proportion of NHB donor kidneys in the total pool of postmortem kidneys differs considerably between countries. In The Netherlands, the proportion is nearly 50%. This figure is markedly higher than that in the US and Canada, where national programs have now been initiated to increase rates of NHB donation. In the future, warm preservation techniques might facilitate better viability testing, thereby increasing NHB donation from category I and II donors and further reducing the shortage of kidneys available for transplantation.
可用于移植的肾脏一直短缺。因此，在20世纪80年代初，我们发表了非心脏跳动（NHB）捐赠的概念；也就是说，从死亡伴有不可逆循环骤停的供体获取肾脏。NHB供体一般使用四种定义进行分类；III类（等待心脏骤停）和IV类（脑死亡时心脏骤停）——即“可控”——供体最适合启动NHB捐赠项目。使用这类供体的肾脏与移植肾功能延迟相关，但对短期或长期的移植肾存活没有影响。使用I类（到达医院时已死亡）和II类（复苏失败）或“不可控控”供体的肾脏同样与移植肾功能延迟相关，但也与原发性无功能风险增加有关。对这些来源的捐赠器官进行活力测试是移植的先决条件。机器保存参数和酶释放测量有助于区分有活力和无活力的肾脏。NHB供体肾脏在尸检肾脏总数中的比例在不同国家有很大差异。在荷兰，这一比例接近50%。这一数字明显高于美国和加拿大，这两个国家目前已启动国家项目以提高NHB捐赠率。未来，热保存技术可能有助于更好地进行活力测试，从而增加I类和II类供体的NHB捐赠，并进一步减少可用于移植的肾脏短缺。
