Pre-kidney transplant evaluation from a cadaver

What is it?

According to Italian law, nowadays potential donors are recognized as all individuals who die with confirmed neurological criteria (Heart-beating donor) or cardiac criteria (Non-Heart-beating donor).

For adult kidney transplant recipients 2 categories of cadaveric donor are distinguished:

  • "Standard" donor: a person aged between 18 and 70 years who does not have, from the anamnestic collection (medical history) and examinations carried out, relevant pathologies
  • “Extended criteria” donor: a donor over 70 years of age or a donor with one of the following conditions (diabetes mellitus under dietary or oral hypoglycemic treatment, treated hypertension, proteinuria> 1gr/24 hours).

In the case of the "standard" donor, after organ removal and in the absence of macroscopic surgical contraindications, transplantation will be performed.

In the case of the "extended criteria" donor, in order to better understand the suitability of the organ for transplantation, a biopsy of the organ will be performed on the operating table and the extracted organs will be placed in a perfusion machine.

The integrated data obtained from the biopsy and the perfusion machine will allow to define the "quality" of the kidney as follows:

  • "Standard" kidney: the two kidneys will be assigned to 2 different recipients
  • “Marginal" kidney: the two kidneys will be transplanted into the same recipient selected from a specific list
  • “Unsuitable" kidney: The two kidneys will not be transplanted.

When is this exam indicated?

The assignment of organs is mainly based on the characteristics of the blood group (A,B,O) and the major histocompatibility system (HLA). The waiting time on the list is not predictable and depends only on the availability of compatible organs.     

How is it performed?

The transplant recipient is summoned to the hospital when the transplant kidney becomes available. Once at the hospital, the recipient performs the final pre-operative tests (blood tests, chest x-ray and electrocardiogram) and is directed to the operating room.    

Contraindications

The assessment of the suitability of the donor´s organs and tissues is aimed at minimizing the risk of transmission of diseases from donor to recipient following transplantation, infectious or neoplastic. On the basis of risk characteristics donors are classified:

A - STANDARD DONOR

This risk class includes all donors with no risk factors for transmissible diseases emerging from the evaluation process.

B - ELIGIBLE NON STANDARD DONOR

B.1 with negligible risk

This level of non-standard risk includes cases in which risk factors are detected in the donor but these factors do not imply any restriction in the selection of recipients because they are not such as to determine the onset of disease or an increased risk of failure of the transplant and/or mortality of the recipient.

B.2 with acceptable risk

This includes cases in which the use of the organs of these donors is justified by the fact that it does not lead to any change in the success rate of the transplant and/or the survival of the patient.

B. 3 unacceptable risk

Donor organs cannot be used due to the presence of pathogens or transmissible diseases that pose a risk to recipients

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