Selection criteria for donors

Selection criteria for cadaveric organ donation include general criteria common for any organ and organ-specific criteria.

Table 2: Irish General selection criteria for cadaveric organ donation

Multi Organ Donor Criteria
1	Age $<$ 70 years
2	The patient has suffered irreversible brain damage resulting in brain stem death
3	The patient is maintained on a ventilator
4	The patient has no major untreated sepsis
Absolute contraindications
1	Current Sepsis
2	Malignancy (Except biopsy proven primary brain tumor)
3	Positive virology for HIV, Hep B or Hep C

Table 3: Specific criteria for cadaveric kidney organ donation

Age 5-70+ years

No history of renal disease, long standing hypertension or diabetes

Serum creatinine withing normal limits on admission

Cold ischaemia time $<$ 36 hours

Table 4: Specific criteria for cadaveric pancreatic organ donation

Age $<$ 55 years

No history of diabetes or pancreatitis

Cold ischaemia time $<$ 18 hours

Age of the donor is widening, many centers will accept kidneys from elderly donors if their renal function is normal and will also accept kidneys in acute renal failure from younger donors $<$ 50 years of age provided it is a pre-terminal event. Some centers will explore the kidneys of donors $>$ 80 years by laparotomy to see if they appear normal. Paired transplantion has been used where both kidneys from the donor are transplanted into the same recipient if the donor has an elevated creatinine.

Young donors $<$ 5 years of age have not been accepted historically. This was due to fears of lack of developement. Many centers will now accept kidneys from young donors and if they are small will transplant them en-bloc.

Severe aortic atheroma is not a contraindication, the aortic carrell patch may be sacrificed and a shorter artery used following work on the back table.

Marginal donors are best used for non marginal recipients as putting a marginal kidney into a sick recipient is a recipie for disaster.

Table 5: Contraindications to cadaveric organ donation

Refusal of consent

Malignancy (except primary intracanial neoplasms confined within the central nervous system)

Hepatitis B

HIV

Severe damage to the organs under consideration

Untreated systemic sepsis

Organs from hepatitis B of C positive donors have occasionally been implanted in a hepatitis B of C positive recipient in life saveing situations.

Donation for high risk individuals such as intravenous drug abuses should not be accepted as the donation may occur during the time frame of seroconversion, i.e. they have contracted the virus but they have not developed antibodies to it yet so these will not be detected on routine testing.

Urosepsis is not a contraindication provided it is treated in the donor and the recipient. Similarly acute tubular necrosis is not a contraindication as the majority will recover.