Pretransplant injury to the kidney endothelium can occur as an agonal
event in the donor. An extreme example of this is disseminated intravascular
coagulation illustrated in the section on 'Pre-existing disease'. Less severe
damage can occur during the harvesting and transportation of the organ prior
to actual implantation, particularly if pulsatile perfusion pumps are used, or
the organ is flushed with a solution of inappropriate ionic composition. Mild forms
of endothelial injury result in endothelial swelling, and scattered microthrombi
within the glomerular capillaries and small arterioles.