In a cadaveric kidney transplant, the cold ischaemia time is defined as the interval between:

• A Declaration of brain death and cross-clamping of the donor aorta
• B Removal of the kidney from the ice slush and completion of the vascular anastomosis
• C Cross-clamping of the donor aorta and reperfusion of the graft in the recipient ✓
• D Start of organ perfusion with cold preservative solution and removal from storage

Explanation

Cold ischaemia time runs from in situ cooling or cross-clamping of the donor circulation, when organ metabolism stops at low temperature, until reperfusion with the recipient blood at implantation. The period before clamping, while the organ is still perfused at body temperature in the donor, constitutes warm ischaemia time, which is what option D confuses. Minimising cold ischaemia reduces delayed graft function risk.

Reference: Sabiston Textbook of Surgery, 21st ed.

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