Strategies to improve donation after circulatory death kidneys for transplantation

The worldwide need of organs for transplantation exceeds the numbers of available and suitable organs considerably. The shortage of organs has already resulted in measures, such as the increasing use of older organ donors, donors with co-morbidities and donors deceased after a circulatory death (DCD). The organs retrieved from such donors are of inferior quality compared to historical used standard criteria donors. Furthermore, these measures are not solving the problem and therefore additional strategies are necessary to expand the current donor pool. In this thesis we explored different strategies to increase the number but also the quality of DCD kidneys for transplantation. Important focus of this thesis is the use of machine perfusion, a dynamic preservation strategy in which kidneys are provided with nutrients and oxygen while being outside the body. These strategies can be helpful in increasing the quality and thus transplant outcomes but also to test kidneys that are now seem not transplantable to test them prior to transplantation.