[Non-heart-beating kidney donors: first improve ischemic times, then allocation].

A study recently published in The Lancet investigated the 3-year graft survival of heart-beating (HB) and non-heart-beating (NHB) kidney donors. This was done utilizing the UK registry. The study concluded that donor age affects graft survival. It also demonstrated that NHB kidneys tolerate cold ischemia less well than kidneys from HB donors. Based on these conclusions, it is suggested that a different allocation algorithm should be designed in order to reduce ischemic time for NHB donor kidneys. These findings are relevant to the Dutch situation in which more than 50% of postmortal kidney donors are now NHB. Despite past efforts, ischemic times in the Netherlands can still be improved compared to neighbouring countries. It is proposed that this matter be dealt with prior to changes in the allocation algorithm.