Successful Kidney Donation Following Long-Term Normothermic Regional Perfusion: Challenges of the First Uncontrolled Donation After Circulatory Death in Iran.

The global organ donation crisis continues to escalate despite advancements in medical procedures. Uncont-rolled donation after circulatory death provides an alternative method to increase the donor pool, especially for kidney transplants. This case study from Iran offers insights into the complex, yet essential, facets of organ procurement under uncontrolled donation after circulatory death protocols. A 38-year-old woman experienced a severe cerebrovascular accident and subsequent cardiac arrest. She was declared for uncontrolled donation after circulatory death, and her organs were preserved using cardiopulmonary bypass for 6 hours. Notably, her kidneys were successfully removed and transplanted into 2 recipients: a 43-year-old man with chronic kidney disease due to hypertension and a 48-year-old man with chronic kidney disease associated with diabetes mellitus. The first recipient experienced initial complications with kidney function that required a prolonged hospital stay, but he eventually exhibited improved renal function. The second recipient experienced fluctuating kidney function initially, which stabilized, demonstrating the practical viability of kidneys procured through uncontrolled donation after circulatory death. This pioneering case in Iran underscores the potential of uncontrolled donation after circulatory death to expand organ procurement and addresses critical medical, ethical, and legal challenges. We emphasize the need for refined protocols that reduce wait times and improve organ viability, thereby contributing to the broader organ donation network. Future research should focus on enhancement of normothermic regional perfusion techniques to improve outcomes for both donors and recipients.