How do you approach the decision to perform preimplantation biopsies in brain-dead kidney donors?

Full Disclosure: This is an opinion from a transplant nephrologist who does not take direct organ offers, but someone who bore witness to many offers that did involve a preimplantation biopsy. The use of preimplantation biopsy appears to be most useful in cases where the clinical parameters would suggest the kidney offered may have suboptimal outcomes. In the case of DBD offers, these would tend to be those from what would have been traditionally called extended criteria donors, or more recently, those with higher KDRI/KDPI scores. There are many scoring systems out there for how preimplantation biopsies are graded, the Remuzzi, Karpinski, and 2017 BANFF Consensus scores, all of which incorporate 4 main factors: degree of interstitial fibro...

This is a really controversial topic and is often driven by the surgeon. Higher KDPI kidneys are more likely to have a biopsy to assess degree of interstitial fibrosis and therefore help guide whether the kidney should be used, discarded, or used with the mate kidney for dual transplantation. In addition there are a few considerations: 1. Sampling errors - often the biopsies taken intraoperatively are subcapsular where the greatest degree of fibrosis may be noted 2. Processing - samples are often fresh frozen as opposed to permanent fixed. The architecture of fresh frozen samples is not as intact as permanent fixed. 3. Variability in reading of the pathology Not all pre-implantation biopsies are read by renal pathologists so there has been ...