*Purpose: DCD kidney transplants are associated with higher rates of delayed graft function (DGF) and primary non-function (PNF) likely due to ischemic events during recovery. Pre-recovery heparin administration is believed to optimize organs for donation by improving perfusion and preventing thrombosis. Many clinicians are hesitant to accept DCD organs that did not undergo pre-mortem heparinization for fear of poor graft function, potentially contributing to discard. Few studies have examined whether absence of pre-mortem heparinization impacts transplant outcomes.

*Methods: SRTR data of DCD kidneys recovered for transplantation from January 1, 2003 to March 10, 2017 were identified. Exclusions were unknown or missing heparin status (n=977) and positive HIV (n=12), HTLV(n=33), Hepatitis B surface antigen (n=26), or Hepatitis C status (n=662) rendering 25,601 kidneys recovered from which there were 20,011 transplants.

*Results: DCD donors not receiving heparin have decreased from 2003 to 2016 despite an increase in total DCD donors (figure). Transplantation of recovered DCD kidneys occurred in 90.1% when donors received pre-mortem heparinization and 91.1% when pre-mortem was not administered (p=0.03).Five-year graft survival of no-heparin (n=1814) vs. heparin groups (n=18,197) was similar (83.68% and 84.42%). On multivariate analysis, lack of heparin use was associated with similar overall graft survival (aHR 0.99, 95% CI 0.87-1.12) and odds of overall discard (aHR 1.04, 95% CI 0.90-1.20, p=0.601).

*Conclusions: DCD kidneys from donors that have not received pre-mortem heparin administration have acceptable transplant outcomes and are not associated with discard.

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