Introduction: The recent expansion in donation after circulatory death (DCD) kidney transplantation within the UK has raised questions regarding donor suitability, particularly relating to the evaluation and use of kidneys from elderly donors. Although national sharing was not obligatory initially, an NHSBT policy change in 2009 advised national offering of DCD kidneys refused by the regional centre. We report our experience using DCD kidneys declined by other centres.

Methods: A retrospective review of DCD kidney offers to our centre from April 2008 to March 2012 was performed. Donor characteristics, reasons for non-acceptance by the regional centre and graft outcomes for those transplanted (primary non-function (PNF), delayed graft function (DGF), one year estimated GFR and graft survival [censored for death with functioning graft]) were analysed.

Results: During the study period, 343 DCD kidneys were offered from outside our region; with 52% of total offers occurring in the last year. We accepted 104 (30%) kidneys, these had been declined by the primary centre for reasons including: donor age, past medical history and logistical problems. Of the 104, we subsequently declined 51 (49%) for reasons including: failure to reach asystole in the donor; damage and macroscopic disease or histological confirmation of significant chronic disease. The median (range) donor age was 58 (1-77) years, 17 (32%) were less than 60 years old and 12 (22%) were greater than 70. Two deaths were trauma-related. Median (range) terminal donor creatinine was 88 (26-191). Despite transit (median ⦥ distance: 93.2 miles [58.9-166.8]), acceptable cold ischaemic times were achieved (median; range: 17h28m; 6h46m – 24h21m), with both kidneys from five donors implanted into single recipients. Of the 48 recipients transplanted, there were 2 cases of PNF. There were two cases of early graft loss due to vascular complications. DGF occurred in 29 (60%) and lasted for an average (range, SD) 17 days (1-113, 26.9). Estimated median (range) GFR at one year was 41 (7->60). Three deaths occurred during follow up, all from sepsis. Graft survival at one year was 94%, which compares to 91% for the 194 DCD kidneys transplanted from regional donors.

Conclusions: Our results demonstrate acceptable outcomes for kidneys accepted from outside our region, despite farther transit. We suggest that there is potential for widening the donor pool and reducing discard rates by using a national sharing scheme for DCD kidneys.

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