In most countries, organ donation from donors without a heartbeat can only take place if the donor dies within one hour of removing their life sustaining treatment. In the United Kingdom, kidneys can still be donated up to three hours after withdrawing this support.

Now, in a study published today in JAMA Network, scientists at Newcastle University have shown the quality of donor kidneys is unaffected by the time between withdrawing life support and the donor dying.

Experts are now calling on international organ donation organisations to consider changing their policies to help increase the number of organs available.

Time to death rules

Most countries have strict time to death rules and if the donor has not died within one hour after their life support is removed, the donation team leave, and the organs are not used for transplant.

However, in the UK teams wait a minimum of three hours, and scientists have found that to wait a few extra hours is beneficial to helping save as many lives as possible.

Based on current trends in the United States, if this country alone adopted the three hour rule, this could mean an extra 1,000 kidney transplants in America per year, and many more across the globe.

Samuel Tingle, Clinical Research Fellow at Newcastle University, who led the study, said: “Our study debunks the idea that a one hour time to death is crucial for maintaining the health of organs.

“What we show is that a longer time to death does not impact the quality or success of kidneys, but it does increase the number of kidneys donated. This offers benefits for patients on the waiting list, potential organ donors and donor families.

“Increasing the number of kidneys internationally could have a huge impact on transplant waiting lists, saving many more lives. Getting patients off dialysis also massively improves their quality of life.

“Raising the number of kidneys which are successfully donated from consented donors also makes sure we are respecting the wishes of donors and their families wherever possible.”

The research is a statistical analysis of data from the UK Transplant Registry. Researchers used anonymised information from 7,183 kidney transplant recipients between 2013 and 2021.

It is the largest study ever to focus specifically on time to death policies with kidney donation. Previous research, led by the same Newcastle team, has shown that longer time to death waiting times did not damage livers or pancreases.

‘Wonderfully simple change’

Mr Tingle, also an Honorary Clinical Research Fellow at The Newcastle upon Tyne Hospitals NHS Foundation Trust, said: “We believe that organ donation organisations internationally should implement the UK policy of waiting a minimum of three hours after removing life support from potential donors. 

“This is a wonderfully simple change that could be made worldwide to safely increase the number of kidneys available for transplant.”

The study was led by Newcastle University and involved Cambridge University, University of Wisconsin, Guy’s Hospital and NHS Blood and Transplant. It was supported by funding from the National Institute for Health and Care Research (NIHR) Blood and Transplant Research Unit in Organ Donation and Transplantation, the MRC and Wellcome.

Further research, in collaboration with NHS Blood and Transplant, will look at whether the time to death wait can be increased to more than three hours and still maintain the quality of the organ.

Dale Gardiner, associate medical director for deceased organ donation at NHS Blood and Transplant, said: "The UK has been a world-leader in this type of organ donation for over a decade.

“It is a privilege to share this expertise with the world so that more lives can be saved through the gift of organ donation."

Reference: Donor time to death and kidney transplant outcomes in a setting of a 3-hour minimum wait policy. Samuel J. Tingle et al. JAMA Network.