Uncontrolled donation after cardiac death kidney transplantation: Opportunity to expand the donor pool?

Published:December 19, 2022DOI:


      • Ten-year graft and patient survival similar between uDCD and cDCD kidney allografts.
      • uDCD kidney allograft recipients experienced higher rates of primary non-function.
      • uDCD is a viable source of kidney allografts amid shortages in the US organ pool.



      Compared to controlled donation after cardiac death (cDCD), uncontrolled DCD (uDCD) kidney transplantation remains an underutilized resource in the United States. However, it is unclear whether long-term allograft outcomes following uDCD are inferior to that of cDCD kidney transplantation.


      From January 1995 to January 2018, the OPTN/UNOS database was queried to discover all reported cases of uDCD and cDCD kidney transplantation. Primary non-function, delayed graft function, ten-year graft and patient survival were compared among uDCD and cDCD patients.


      Rates of primary non-function (4.0% [uDCD] vs. 1.8% [cDCD], P < 0.001) and delayed graft function (51.1% [uDCD] vs. 41.7% [cDCD], P < 0.001) were higher following uDCD transplant. However, ten-year graft survival (47.5% [uDCD] vs. 48.4% [cDCD], P = 0.21) and patient survival were similar to cDCD transplantation (59.4% [uDCD] vs. 59.2% [cDCD], P = 0.32).


      Although initial allograft outcomes are inferior following uDCD, long-term durability of uDCD kidney allografts is on par to cDCD transplantation. Kidney allografts derived by uDCD may be a viable and durable option to increase the donor pool.

      Graphical abstract


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        • Thuong M.
        • Ruiz A.
        • Evrard P.
        • et al.
        New classification of donation after circulatory death donors definitions and terminology.
        Transpl Int. 2016; 29: 749-759
        • Evrard P.
        • Belgian Working Group on DCD National Protocol
        Belgian modified classification of Maastricht for donors after circulatory death.
        Transplant Proc. 2014; 46: 3138-3142\
        • Choudhury R.A.
        • Prins K.
        • Moore H.B.
        • Yoeli D.
        • Kam A.
        • Nydam T.L.
        Uncontrolled deceased cardiac donation: an unutilized source for organ transplantation in the United States.
        Clin Transplant. 2019; 33e13474
        • Gagandeep S.
        • Matsuoka L.
        • Mateo R.
        • et al.
        Expanding the donor kidney pool: utility of renal allografts procured in a setting of uncontrolled cardiac death.
        Am J Transplant. 2006; 6: 1682-1688
        • Hoogland E.R.
        • Snoeijs M.G.
        • Winkens B.
        • Christaans M.H.
        • van Heurn L.W.
        Kidney transplantation from donors after cardiac death: uncontrolled versus controlled donation.
        Am J Transplant. 2011; 11: 1427-1434
        • Light J.A.
        • Barhyte D.Y.
        • Gage F.A.
        • Sasaki T.M.
        • Aquino A.O.
        Long-term graft survival after transplantation with kidneys from uncontrolled nonheartbeating donors.
        Transplantation. 1999; 68: 1910-1911
        • Light J.A.
        • Kowalski A.E.
        • Sasaki T.M.
        • et al.
        A rapid organ recovery program for non-heart-beating donors.
        Transplant Proc. 1997; 29: 3553-3556
        • Light J.A.
        The Washington, D.C. experience with uncontrolled donation after circulatory determination of death: promises and pitfalls.
        J Law Med Ethics. 2008; 36 (735-610)
        • Reich D.J.
        • Mulligan D.C.
        • Abt P.L.
        • et al.
        ASTS recommended practice guidelines for controlled donation after cardiac death organ procurement and transplantation.
        Am J Transplant. 2009; 9: 2004-2011
        • Hart A.
        • Smith J.M.
        • Skeans M.A.
        • et al.
        OPTN/SRTR 2016 annual data report: kidney.
        Am J Transplant. 2018; 18 (Suppl 1): 18-113
        • Miñambres E.
        • Rubio J.J.
        • Coll E.
        • Domínguez-Gil B.
        Donation after circulatory death and its expansion in Spain.
        Curr Opin Organ Transplant. 2018; 23: 120-129
        • Molina M.
        • Guerrero-Ramos F.
        • Fernández-Ruiz M.
        • et al.
        Kidney transplant from uncontrolled donation after circulatory death donors maintained by nECMO has long-term outcomes comparable to standard criteria donation after brain death.
        Am J Transplant. 2019; 19: 434-447
        • Ortega-Deballon I.
        • Hornby L.
        • Shemie S.D.
        Protocols for uncontrolled donation after circulatory death: a systematic review of international guidelines, practices and transplant outcomes.
        Crit Care. 2015; 19 (Published 2015 Jun 24): 268
        • Demiselle J.
        • Augusto J.F.
        • Videcoq M.
        • et al.
        Transplantation of kidneys from uncontrolled donation after circulatory determination of death: comparison with brain death donors with or without extended criteria and impact of normothermic regional perfusion.
        Transpl Int. 2016; 29: 432-442
        • Magliocca J.F.
        • Magee J.C.
        • Rowe S.A.
        • et al.
        Extracorporeal support for organ donation after cardiac death effectively expands the donor pool.
        J Trauma. 2005; 58: 1095-1102
        • Oniscu G.C.
        • Randle L.V.
        • Muiesan P.
        • et al.
        In situ normothermic regional perfusion for controlled donation after circulatory death--the United Kingdom experience.
        Am J Transplant. 2014; 14: 2846-2854
        • Kirby J.
        Is there a particular ethical practice and policy space in north America for uncontrolled kidney donation after circulatory death?.
        J Law Med Ethics. 2017; 45: 142-148
        • Le Dinh H.
        • de Roover A.
        • Kaba A.
        • et al.
        Donation after cardio-circulatory death liver transplantation.
        World J Gastroenterol. 2012; 18: 4491-4506
        • Reed M.J.
        • Lua S.B.
        Uncontrolled organ donation after circulatory death: potential donors in the emergency department.
        Emerg Med J. 2014; 31: 741-744
        • Wall S.P.
        • Kaufman B.J.
        • Gilbert A.J.
        • et al.
        Derivation of the uncontrolled donation after circulatory determination of death protocol for New York city.
        Am J Transplant. 2011; 11: 1417-1426
        • Wall S.P.
        • Kaufman B.J.
        • Williams N.
        • et al.
        Lesson from the New York city out-of-hospital uncontrolled donation after circulatory determination of death program.
        Ann Emerg Med. 2016; 67 (e39): 531-537
        • Volk M.L.
        • Warren G.J.
        • Anspach R.R.
        • Couper M.P.
        • Merion R.M.
        • Ubel P.A.
        Attitudes of the American public toward organ donation after uncontrolled (sudden) cardiac death.
        Am J Transplant. 2010; 10: 675-680