Browse by author
Lookup NU author(s): Dr George KourounisORCiD, Abdullah Malik, Dr Emily ThompsonORCiD, Dr Emily Glover, Professor Neil SheerinORCiD, Dr Sam Tingle
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
Background: Time to death (TTD) following withdrawal of life-sustaining treatment is variable among potential donation after circulatory death (DCD) donors. Concerns persist that prolonged TTD may impair organ quality. Although previous European studies have demonstrated that prolonged TTD does not impact post-transplant kidney graft survival, it remains unclear whether these findings apply to the US donor pool. Methods: We used the OPTN data on adult DCD single-kidney transplants (2010-2023). Multiple imputation was used for missing data. Multivariable regression models, restricted cubic splines for non-linear relationships, were used to evaluate the impact of donor TTD on kidney transplant outcomes. Results: Median donor TTD was 14 minutes (IQR, 10–21 minutes). Donor TTD was not associated with recipient graft survival (p=0.469), mortality (p=0.528) or 1-year eGFR (p=0.393). These findings were consistent regardless of normothermic regional perfusion use (NRP cohort: n=1,227; non-NRP cohort: n=35,328), and within the large ex-situ hypothermic machine perfusion cohort (HMP cohort: n=22,218). Only 4.1% of transplanted DCD kidneys were from donors with TTD of over 60 minutes, and just 0.1% exceeded 120 minutes. Conclusions: The use of kidneys from donors with prolonged TTD did not negatively affect post-transplant outcomes. In contrast to the US setting, a previous UK study reported higher utilisation rates from prolonged TTD donors (12.3% of donors with TTD >60 minutes; 4.2% with TTD >120 minutes). This highlights an opportunity to safely expand the US DCD donors pool, especially in the era of machine perfusion where viability assessment may provide an additional safeguard.
Author(s): Amarnath DR, Kalpana TS, Kourounis G, Malik AK, Philip J, Thompson ER, Glover E, Pettigrew GJ, Callaghan C, Sheerin NS, Wilson C, Tingle SJ
Publication type: Article
Publication status: Published
Journal: Clinical Transplantation
Year: 2026
Volume: 40
Issue: 4
Online publication date: 24/04/2026
Acceptance date: 07/04/2026
Date deposited: 14/04/2026
ISSN (print): 0902-0063
ISSN (electronic): 1399-0012
Publisher: Wiley
URL: https://doi.org/10.1111/ctr.70548
DOI: 10.1111/ctr.70548
ePrints DOI: 10.57711/d5v5-rm19
Data Access Statement: The data used in this manuscript was provided to us by OPTN. The raw data may be requested from OPTN through written request.
Altmetrics provided by Altmetric
