Thousands of people suffer out-of-hospital cardiac arrest worldwide every year, death being declared in situ after 30min. of unsuccessful advanced CPR maneuvers. Some cases could be UDCD Donors (UDCDD) if quickly transferred to the hospital for organ preservation procedures. In July 2005, our hospital and 2 out-of-hospital emergency services (SUMMA 112 and SESCAM) started a UDCD program with non-hospitalized irreversible cardiac arrest subjects who were rapidly transported to the hospital. Until Dec.2011, 181 of 351 potential UDCDDs met the inclusion criteria and were transferred to our hospital by helicopter (49, 27%) or ambulance (132, 73%) under cardiac massage and mechanical ventilation. On arrival to the hospital, medical and legal death was certified after resuscitation maneuvers were interrupted for at least 5 min. and absence of heart beat was confirmed according to Spanish law. Of 181 persons, 152 (84%) could be connected to cardiopulmonary bypass machine using femoral cannulation limited to abdominal cavity (a Fogarty balloon catheter was placed in subdiaphragmatic aorta). Mean time from cardiac arrest to cardiopulmonary bypass was 112±23 min. Kidneys were procured in 127 UDCDD (74.3%) after a 183±34 min. mean time in cardiopulmonary bypass (27 potential donors were lost due to family refusal-16 cases (10%) and other causes-11 cases). Transplant was possible with 175 (69%) of the 254 procured kidneys (48% of all potential UDCDD received in the hospital). Discarded grafts were mainly due ischemia. We transplanted 171 kidneys with mean donor and recipient age of 42±11 and 48±11 yrs., respectively. Immunosuppressive protocol consists of steroids, thymo, mycophenolic acid, and 7 day late onset of tacrolimus. Incidences of primary non-function (PNF), delayed graft function (DGF) and acute rejection were 8%, 88%, and 12%, respectively. Mean SCr was 1.4±0.6mg%, and patient and graft survival 98% and 87%, respectively, with mean follow-up of 18±13mo.(range 6-20 m). In conclusion, out-of-hospital UDCDD is an adequate source of kidneys for transplantation. High tissue ischemic stress due to prolonged cardiac arrest limits organ viability and explains the high incidence of PNF and DGF. However, medium term evolution shows excellent graft and patient survival and SCr.

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