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The use of kidneys from uncontrolled donors after cardiac death (uDCD) remains disputable due to significant warm ischemia time (WIT) causing ischemia-reperfusion injuries. The aim of study was to use machine perfusion as a tool for preoperative selection and recovery of kidneys obtained from 22 uDCDs from December 2005 until July 2007. The results of transplantation of 21 pump-perfused kidneys (study group) were compared with 17 cold-stored kidneys (control group) from the same donors. The use of pulsatile perfusion allowed kidney transplantation from nine marginal uDCDs with extreme WIT (59 to 65 minutes). At the same time, we discarded five paired kidneys from the control group. The rate of immediate function among the study group was 30% greater than that in the control group. The creatinine level in control group was twice as high on day 21 and at 3 months after transplantation than among the study group. A considerable number of complications and the negative effects correlated with the cold-stored group of kidneys. In conclusion, machine perfusion is an instrument to select kidneys from uDCDs at the preoperative stage, thereby improving postoperative function of these grafts.

Protection of grafts from ischemia-reperfusion injury (IRI) remains an important problem, especially in uncontrolled donors. This study was performed to define the effect of oxygenated perfluorocarbonic emulsion for initial in situ conservation. One hundred and seventeen kidney grafts were procured from 2003 until 2006 from sixty one DCDs of Maastricht II and IV category. Control group donors (HTK group, n = 31) were operated using the traditional rapid laparotomy. The study group donors (Perftoran group, n = 30) had femoral access obtained in the ICU with initial perfusion by perfluorocarbonic PFG emulsion. The recipients were divided according to the type of the initial perfusion of the kidneys into a control group (n = 59) whose kidneys were initially perfused using HTK solution, and a study group (n = 58), who received kidneys preserved with initial perfusion in situ using oxygenated Perftoran. The rate of delayed graft function was significantly (up to 30%) higher among the control group. In the study group, the rate of immediate function was twice as high as that in the control group. By postoperative day 21, the level of serum creatinine in the study group decreased twice that of the control group. Initial perfusion with oxygenated perfluorocarbonic emulsion in situ may minimize a IRI of DCD kidneys.

Russian transplantology is quite far from first place in the world. The post-Soviet mistrust to social and medical service resulted in dramatic reduction of transplantations in some regions of Russia during the last 10 years. The level of organ donation depends on public trust and a proper form of the donation process. The reasons for the organ donation crisis are well known. First, it is the so-called "command form of organ donation" inherited from the Soviet medical system. The longtime model of obtaining donor organs from deceased individuals caused negative public opinion. Organ donation was considered to be an activity that violated the dead and living rights. As a result, we need new forms of professional collaboration between transplantologists and intensive care unit specialists. The northwest Region of Russia created the first model of transplant coordination in 2006. There were regional transplant coordinators (as a part of a procurement center) and local (hospitals) coordinators. During 2006, this initiative was emotional and enthusiastic; after 2007, this initiative received financial support from the local government. As a result, there is an increasing number and changing quality of organ donations. In 2007, the total number of organ donors in Saint Petersburg now is 8.7 per million compared with 2.5 per million in 2005.