Survey of the use of perfusion parameters as a selection tool for pumped deceased donor kidneys in the Organ Procurement Organizations of North America

BackgroundHypothermic machine perfusion (HMP) has become a standard method for preserving deceased donor kidneys, offering advantages over static cold storage. Perfusion parameters like renal vascular resistance (RR) have been explored as potential decision-making tools for kidney transplantability, but their clinical use remains unclear. AimWe aimed to investigate the use of perfusion parameters in decision-making regarding the acceptance of pumped deceased donor kidneys among Organ Procurement Organizations (OPOs) in the USA and Canada. MethodsAn anonymous, internet-based survey was sent to 69 OPOs in the USA and Canada, collecting data on the use of HMP, perfusion parameters, and thresholds for transplantability decisions. Descriptive statistics were used for analysis. ResultsOf the 67 OPOs contacted, 15 (22%) responded, with 13 complete responses (87%). All OPOs used HMP, with 93% perfusing both donation after brain death and circulatory death kidneys. While 97% of OPOs used perfusion parameters in decision-making, none relied solely on these parameters. Two OPOs (15%) did not use them at all, while six OPOs (46%) considered them with other data or on a case-by-case basis. Only one OPO (9%) reported using specific thresholds for perfusion parameters, applying flow [&ge;]100 mL/min, resistance <0.3 mmHg/mL/min, and pressure between 15-35 mmHg. ConclusionHMP is widely used, but substantial variability exists in the use of perfusion parameters for transplant decisions. Most OPOs do not rely on these parameters alone and lack standardized thresholds, though specific thresholds are still used.