In 2007, a landmark decision that is supported by the international transplant community, the Chinese national government has established regulations to gradually abolish the use of organs from executed prisoners and created a legal and sustainable voluntary organ donation system. Currently in China, even the potential donors who met the criteria of brain death still have to wait for circulatory arrest before organ donation. With the collaborations of the Chinese central government, the Red Cross Society and Chinese Transplantation Society, the number of donation after circulatory death (DCD) donors has increased rapidly in recent years.

We report 71 DCD kidney transplants performed in our hospital at Sun Yat-sen University between February, 2007 and June, 2012 with aims to demonstrate the results of DCD kidney transplantation and risk factors associated with kidney allograft outcome. The primary non-function rate was 2.8%, and delayed graft function rate was 28.2%. The 1-year and 3-year graft survival was 95.7% and 92.4%. Donor age, serum creatinine level before recovery, and hypertension history were negatively correlated with 1-year eGFR after transplant. Donor age >40 years, hypertension, cold ischemia time >24h, and serum creatinine before recovery of >115Μmol/L were independent risk factors for delayed graft function after DCD kidney transplantation. The discarded kidneys and DGF grafts had lower flow rates and higher resistant indices.

In conclusion, graft survival of DCD kidney transplantation is excellent despite of higher rates of primary non-function and delayed graft function after transplantation. Donor age, pre-recovery donor serum creatinine, hypertension history, cold ischemia time, resistant index and flow rate are useful factors to predict graft outcomes after DCD kidney transplantation. This report illustrates the initial success in of creating a legal and sustainable voluntary organ donation system in China.

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