Kidney recovery from the multiple organ donor.

Although knowledge of the details of heart, lung, liver, or pancreas dissections is not critical for urologists doing only renal procurement, understanding the principles of multiple organ procurement is important if quality kidneys are to be obtained. The needs of the various recipients must be kept in mind, especially those of heart, lung, and liver recipients, because those organs must function properly every time. Although it may be necessary in an occasional case, especially in small pediatric donors, to remove a heart or liver but not the kidneys, it is not acceptable practice to sacrifice kidneys routinely from multiple organ donors. Low wastage rates of kidneys from multiple organ donors are well documented. Rates of initial nonfunction (ATN) in patients receiving kidneys from multiple organ donors have been about 10 per cent, comparable to the initial nonfunction rates of kidneys from kidney-only donors. Renal procurement operations from cadaver donors will be done frequently in association with procurement of other vital organs. The continued availability of kidneys for transplantation should not be altered by the use of such donors as long as cooperation and careful surgical techniques are employed.