Organ Preservation and Acceptance Guidelines for Kidney Transplantation

Preservation Solutions for Deceased Donor Kidneys

• Deceased donor kidneys must be flushed with a cold preservation solution (University of Wisconsin, Celsior, or Marshall’s hypertonic citrate) and then stored on ice; these solutions have been shown to be equivalent in preserving graft viability【1】【2】.
• The standard protocol for deceased donor kidneys includes an initial cold‑solution flush followed by ice storage, which constitutes the accepted method of static cold preservation【1】【2】.

Preservation Requirements for Living Donor Kidneys

• When immediate transplantation is planned, a simple perfusion with a crystalloid solution is sufficient for living donor kidneys, reflecting the minimal preservation needs under optimal procurement conditions【1】【2】.
• Because living donor kidneys are procured from healthy donors and implanted promptly, they require only minimal preservation measures, avoiding the need for specialized cold‑storage solutions【1】【2】.

Expanded Criteria Donor (ECD) Considerations

• Kidneys from expanded‑criteria deceased donors increasingly require dynamic preservation techniques (e.g., hypothermic machine perfusion) rather than static cold storage, due to their marginal quality and higher susceptibility to ischemic injury【1】【2】.

Histological Evaluation and Organ Acceptance

• Histological assessment alone should not dictate organ acceptance; it must be interpreted together with donor clinical parameters, recipient factors, and, when available, perfusion metrics to make an informed decision on graft suitability【1】【2】.