Does DCDDonor Time‐to‐Death Affect Recipient Outcomes? Implications of Time‐to‐Death at a High‐Volume Center in the United States

For donation after circulatory death (DCD), many centers allow 1 h after treatment withdrawal to donor death for kidneys. Our center has consistently allowed 2 h. We hypothesized that waiting longer would be associated with worse outcome. A single‐center, retrospective analysis of DCDkidneys transplanted between 2008 and 2013 as well as a nationwide survey of organ procurement organization DCDpractices were conducted. We identified 296 DCDkidneys, of which 247 (83.4%) were transplanted and 49 (16.6%) were discarded. Of the 247 recipients, 225 (group 1; 91.1%) received kidneys with a time to death (TTD) of 0–1 h; 22 (group 2; 8.9%) received grafts with a TTDof 1–2 h. Five‐year patient survival was 88.8% for group 1, and 83.9% for group 2 (p = 0.667); Graft survival was also similar, with 5‐year survival of 74.1% for group 1, and 83.9% for group 2 (p = 0.507). The delayed graft function rate was the same in both groups (50.2% vs. 50.0%, p = 0.984). TTDwas not predictive of graft failure. Nationally, the average maximum wait‐time for DCDkidneys was 77.2 min. By waiting 2 h for DCDkidneys, we performed 9.8% more transplants without worse outcomes. Nationally, this practice would allow for hundreds of additional kidney transplants, annually. Hundreds more kidney transplants could be performed in the United States each year if centers were willing to wait up to 2 hours for kidneys procured after circulatory death, with no decrease in outcome.