Renal Transplant Donor
- Donor classification
- Maastricht classification
- Living donor
- Tissue typing and Crossmatch
- Graft function and survival
- Issues facing transplant
1. Classification of kidney donors
- Related donors & unrelated donor
- Altruistic directed or Undirected donation
- Paired donation - single or multiple
- Donation after Brain Death (DBD)
- Donation after cardiac death (DCD)
- Standard criteria donor (SCD)
- Expanded-criteria donor (ECD): a) donor ≥60 yr, or b) aged 50 to 59 yr and any two of three: Hypertension, SCr >1.5 mg/dl, or death by CVA
Link to the article from Clinical Journal of American Society of Nephrology:
2. DBD: Donor with certified brain death,
but cardiac circulation and respiration maintained naturally or by ventilation, drugs, intra-aortic balloon pump, or extracorporeal machine oxygenation device.
3. Donation after cardiac death (DCD):
DCD (old term non–heart-beating donor.
- Cardiac arrest occurs before the organ harvest, spontaneously or controlled way. The DCD categories are of five types:
- Controlled DCD (cDCD), life support withdrawn in controlled operating room.
- Uncontrolled DCD (uDCD), cardiac arrest occurs requiring CPR during procurement of the organs.
- Brought in dead, unsuccessful resuscitation.
- Awaiting cardiac arrest - controlled.
- Cardiac arrest after brainstem death- Uncontrolled.
5. Prognosis of ECD, DBD & DCD
ECD kidney transplantation is associated with a significantly increased risk for delayed graft function (dialysis in the first week after transplant).
DCD kidney: both the graft and recipient survival are similar between DCD and DBD, but increase risk for delayed graft function was 42 to 51% in DCD compared with 24% in DBD kidney transplant recipients.
6. Living donor
Multiple Paired Exchanged Donor
- Related donors
- Altruistic Unrelated directed Donor
- Undirected unrelated donor
(Paired donation - single or multiple)
Living Related Donor
The donor and the recipient have a biologic relationship. 1st & 2nd degree.
- Spouse to spouse Emotional relationship.
- Directed, anonymous donor-specific recipient.
- Altruistic directed
- Undirected, anonymous donor to the waiting list.
- Paired Exchange Donor: A pair of donor–recipient candidates (from the related or unrelated categories) exchange within each other for ABO compatibility or cross-match reactivity.
- Multiple Paired Exchanged Donor. This is paired exchange donation but involves more than two donor–recipient candidate pairs, as shown in the above figure.
Graft survival rates for different types of kidney transplantation.
Unadjusted 1, 3, and 5yr kidney graft survival, by donor type: 2000–2005.