Barriers and Opportunities to Increase Utilization of Donor Kidneys After Death Determined by Circulatory Criteria Among Children and Adults: A Narrative Review
Bibliographic record
Abstract
Purpose of Review: Kidney transplantation is associated with survival benefit compared to dialysis. Yet, there is an unmet need for access to kidney transplantation within Canada and globally. Donation after death determined by circulatory criteria (DCC) has expanded access to kidney transplantation among the adult and pediatric population. However, there are concerns inherent to DCC kidneys, including warm ischemia time and ischemia-reperfusion injury (IRI). This narrative review aims to summarize relevant literature in this context, discuss potential opportunities to expand the use of DCC kidneys, and highlight knowledge gaps for further study. Sources of Information: PubMed (Medline), the Canadian Institute for Health Information, and regulatory bodies for organ donation and transplantation. Methods: A focused review and critical appraisal of existing literature on the mechanisms of kidney IRI, consideration of sex in experimental studies relevant to DCC kidney transplantation, ex vivo perfusion strategies, and pediatric kidney transplant considerations. Key Findings: DCC kidneys confer a higher risk of delayed graft function (DGF) due to prolonged warm ischemic time. However, long-term graft survival is generally comparable to that of kidneys from donors with death determined by neurologic criteria (DNC). Key barriers to expansion include the paucity of sex-balanced experimental studies on DCC graft preservation and outcomes and existing protocols for DCC donor selection, including thresholds for warm ischemia time. Ex vivo strategies including non-oxygenated and oxygenated hypothermic machine perfusion and normothermic ex vivo kidney perfusion are promising research areas. Improving DCC protocols to reduce kidney IRI has the potential to further expand access to DCC transplantation, including to the pediatric population. Limitations: This narrative review only included articles written in English. Study quality was not formally assessed. Discussion points were influenced by the author's areas of expertise.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.016 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.004 | 0.005 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".