{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T05:35:07Z","timestamp":1790660107226,"version":"4.1.0"},"reference-count":30,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"vor","delay-in-days":23,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Concerns persist that prolonged time to death (TTD) following withdrawal of life\u2010sustaining treatment may impair organ quality. Although previous European studies have demonstrated that prolonged TTD does not impact post\u2010transplant kidney graft survival, it remains unclear whether these findings apply to the US donor pool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used OPTN data on adult DCD single\u2010kidney transplants (2010\u20132023). Multiple imputation was used for missing data. Multivariable regression models, with restricted cubic splines for non\u2010linear modelling, were used to evaluate the impact of donor TTD on kidney transplant outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Median donor TTD was 14\u00a0min (IQR, 10\u201321\u00a0min). Donor TTD was not associated with recipient graft survival (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.469), mortality (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.528) or 1\u2010year eGFR (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.393). These findings were consistent regardless of normothermic regional perfusion use (NRP cohort:\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a01227; non\u2010NRP cohort:\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a035\u00a0328), and within the large ex\u2010situ hypothermic machine perfusion cohort (HMP\u2010 cohort:\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a022\u00a0218). Only 4.1% of transplanted DCD kidneys were from donors with TTD of over 60\u00a0min, and just 0.1% exceeded 120\u00a0min.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Increasing donor TTD was not associated with worse post\u2010kidney\u2010transplant outcomes within this cohort predominantly comprising donors with TTD 0\u201360\u00a0min. In contrast to this US setting, a previous UK study reported that a higher proportion of transplanted DCD kidneys were from prolonged TTD donors (12.3% from donors TTD &gt;60\u00a0min; 4.2% from &gt;120\u00a0min). This highlights an opportunity to safely expand the US DCD donor pool, especially in the era of machine perfusion where viability assessment may provide an additional safeguard.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ctr.70548","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T17:35:10Z","timestamp":1777052110000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Time to Death and Donation After Circulatory Death Kidney Transplant Outcomes: Opportunities for Improved Utilization in the United States"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9061-8766","authenticated-orcid":false,"given":"Dharesh Raj","family":"Amarnath","sequence":"first","affiliation":[{"name":"Newcastle University School of Medicine  Newcastle upon Tyne UK"},{"name":"NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University  Newcastle upon Tyne UK"},{"name":"Institute of Transplantation The Freeman Hospital  Newcastle upon Tyne UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanissha Sanjay Raj","family":"Kalpana","sequence":"additional","affiliation":[{"name":"Newcastle University School of Medicine  Newcastle upon Tyne UK"},{"name":"Devarajan Medical Center  Arani Tamil Nadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Kourounis","sequence":"additional","affiliation":[{"name":"NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University  Newcastle upon Tyne UK"},{"name":"Institute of Transplantation The Freeman Hospital  Newcastle upon Tyne UK"},{"name":"Translational and Clinical Research Institute Newcastle University  Newcastle upon Tyne UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah K.","family":"Malik","sequence":"additional","affiliation":[{"name":"NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University  Newcastle upon Tyne UK"},{"name":"Institute of Transplantation The Freeman Hospital  Newcastle upon Tyne UK"},{"name":"Translational and Clinical Research Institute Newcastle University  Newcastle upon Tyne UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Philip","sequence":"additional","affiliation":[{"name":"Division of Transplantation University of Wisconsin School of Medicine and Public Health  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily R.","family":"Thompson","sequence":"additional","affiliation":[{"name":"NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University  Newcastle upon Tyne UK"},{"name":"Institute of Transplantation The Freeman Hospital  Newcastle upon Tyne UK"},{"name":"Translational and Clinical Research Institute Newcastle University  Newcastle upon Tyne UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Glover","sequence":"additional","affiliation":[{"name":"NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University  Newcastle upon Tyne UK"},{"name":"Institute of Transplantation The Freeman Hospital  Newcastle upon Tyne UK"},{"name":"Renal Services, Newcastle Upon Tyne Hospitals NHS Foundation Trust  Newcastle upon Tyne UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gavin J.","family":"Pettigrew","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Cambridge  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Callaghan","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Transplantation Guy's Hospital, Guy's and St Thomas\u2019 NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Sheerin","sequence":"additional","affiliation":[{"name":"NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University  Newcastle upon Tyne UK"},{"name":"Institute of Transplantation The Freeman Hospital  Newcastle upon Tyne UK"},{"name":"Translational and Clinical Research Institute Newcastle University  Newcastle upon Tyne UK"},{"name":"Renal Services, Newcastle Upon Tyne Hospitals NHS Foundation Trust  Newcastle upon Tyne UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin","family":"Wilson","sequence":"additional","affiliation":[{"name":"NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University  Newcastle upon Tyne UK"},{"name":"Institute of Transplantation The Freeman Hospital  Newcastle upon Tyne UK"},{"name":"Translational and Clinical Research Institute Newcastle University  Newcastle upon Tyne 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