Renal allografts from pediatric donors after cardiac death: One case report

doi:10.3969/j.issn.2095-4344.2013.05.009

Abstract

Abstract:

BACKGROUND: The organ shortage is the common difficulty faced by the global transplant community. In order to expand the donor sources, to ease the growing tension of the organ shortage and to avoid confusion caused by the absence of brain death legislation and diagnostic criteria, the Ministry of Health and the Red Cross Society of China have jointly promote the cardiac death organ donation.
OBJECTIVE: To investigate the feasibility of organ donation from pediatric donors after cardiac death.
METHODS: One case of organ donation from a pediatric donor at Fuzhou General Hospital of Nanjing Military Command of PLA was retrospectively analyzed combined with the analysis of the literatures.
RESULTS AND CONCLUSION: A 4-year-old boy was independently diagnosed with brain death after cardiopulmonary resuscitation by two groups of specialists at an interval of 24 hours. The criteria included the Diagnostic Criteria for Brain Death (for adults), the Technological Specification for Brain Death (for adults) and atropine test results. The donor parents should be informed and consent with the donor programs and fully expressed the donation willingness, and the program should be approved by the hospital ethics committee. The following steps including donation application, approval, transportation, organ maintaining, mechanical support removal and organ recovery were conducted according to the organ donation guidelines in China after cardiac death. The warm ischemia time was 13 minutes. Two renal grafts were transplanted to two uremic recipients selected by age, weight and human leukocyte antigen matching. The left kidney recipient was a 13-year-old female patient and the right kidney recipient was a 35-year-old female patient. No complications such as delayed graft function, renal graft vascular thrombosis, urinary fistula or ureteral obstruction were observed. The graft length was increased from 7 cm postoperation to 10 cm at 1 year after operation, with negative proteinuria, serum creatinine of 60 μmol/L and estimated glomerular filtration rate was ranged from 70 to 150 mL/min. No long term complications such as serious infections, hypertension, diabetes, hyperlipidemia or liver dysfunction were observed. The recipients have good levels of daily living activities, psychological status and adherence. Organ donation from pediatric donors after cardiac death was one of the alternative solutions to the shortage of organ sources in transitional period. We should explore the standardized operating procedures of pediatric donation after cardiac death based on the top priority principles of patient interests.

Key words: organ transplantation, renal transplantation, cardiac death, organ donation, child, brain death, kidney, warm ischemia time, renal function, ethics, complications, tissue typing

CLC Number:

R318

Yang Shun-liang, Guo Jun-qi, Zhang Wei, Wu Xiao-zhi, Gao Xia, Cai Jin-quan, Tan Jian-ming. Renal allografts from pediatric donors after cardiac death: One case report[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(5): 817-824.

Figures/Tables 5

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