Optimizing the timing of organ procurement from donors after brainstem death: Impact on outcomes in abdominal organ transplantation - A systematic review.

Organ transplantation remains the gold-standard treatment for end-stage organ failure, with brain-dead donors being the primary source of transplantable organs. The timing of organ procurement-particularly the interval between brain death declaration and cold perfusion-has emerged as a critical factor influencing graft outcomes. This systematic review synthesizes evidence on the impact of procurement timing on liver, pancreas, and kidney transplantation outcomes. A comprehensive literature search identified six studies (196,389 patients) meeting inclusion criteria. For patients undergoing liver transplantation, longer procurement intervals (median 34.6 vs. 10.5 h) were associated with improved graft survival and reduced acute rejection. In patients undergoing pancreas transplantation, each 10-h delay correlated with a 5.6 % reduction in graft loss and a 6.3 % lower rejection risk. Studies looking into outcomes after kidney transplantation demonstrated that extended intervals (>20 h) reduced delayed graft function (DGF) in younger donors and improved long-term graft survival, without increasing rejection rates. Contrary to traditional beliefs, prolonged procurement intervals did not harm abdominal organ viability and, in some cases, enhanced outcomes, likely due to improved donor stabilization and reduced inflammatory injury. These findings suggest that transplant teams can adopt more flexible procurement timelines while maintaining graft quality. However, study heterogeneity and limited data warrant further research to refine optimal timing strategies. This review supports a paradigm shift toward individualized, organ-specific procurement protocols to maximize transplantation success.