*Purpose: A retrospective review of cases from one large organ procurement organization (OPO) was performed to determine whether the delivery of RRT as a component of donor management led to successful procurement and transplantation of deceased donor organs.

*Methods: All cases from 1/1/16 – 11/20/18 were searched for patients with consent for organ donation, a peak creatinine > 3 mg/dL, and any history of RRT. These individual records were searched to identify whether RRT was delivered during the terminal hospitalization and which organs were procured and transplanted. Post-transplant outcomes were obtained from TIEDI.

*Results: 17 patients were identified; all were brain dead. 16 livers, 2 hearts, 2 lungs and 2 kidneys were transplanted into 21 patients. Follow-up data was available for 20/21 recipients. Most (11/17, 65%) had preexisting endstage renal disease (ESRD) and a mean age of 52.9 years. 6 (35%) had acute kidney injury and a mean age of 46.5 years. The mean length of stay was 7.9 days (range 3 – 20). Organs were procured and transplanted from 16 of 17 patients; cirrhosis was newly identified intraoperatively in 1 patient from whom no organs were recovered. Follow-up data was available for 15 of 16 liver recipients; 80% (12/15) were alive with graft function at 30 days. Both kidneys exhibited delayed graft function but are working 6 months post-transplant. Both lungs (1 recipient) are functioning 2 months post-transplant. Both heart recipients were alive 6 months post-transplant.

*Conclusions: CMS requires hospitals to “maintain potential donors while necessary testing and placement of potential donated organs, tissues and eyes take place”. But renal replacement therapy is often withheld due to futility of the index patient. With the length of stay for most donors > 7 days, and an established mean survival of 7.4 days following dialysis withdrawal, it is apparent that RRT should be delivered to preserve the option of organ donation in suitable patients. The wonderful paradox of utilizing these RRT resources to save the lives of transplant candidates, despite the expected deaths of these organ donors, should be emphasized to hospitals, intensivists + nephrologists whose collaboration is sought.

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