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Expanded criteria donors: attempts to increase the renal transplant donor pool
A K Mandal1, A N Kalligonis, L E Ratner
1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Insights
Kidney transplants are increasing using organs from expanded criteria donors, who may have health issues. Careful recipient selection is key to successful outcomes with these valuable organs.
Area of Science:
- Nephrology
- Transplant Surgery
- Public Health
Background:
- Increasing demand for kidney transplants and changing donor demographics necessitate broader donor criteria.
- The average organ donor is older, has more comorbidities (hypertension, viral infections), and is more likely to die from cerebrovascular disease.
- This has led to the expansion of criteria for identifying suitable organ donors.
Purpose of the Study:
- To review factors contributing to successful kidney transplantation from expanded criteria donors.
- To discuss the efficacious allocation of these organs to appropriate recipients.
- To address the challenges and opportunities presented by expanded criteria donor kidneys.
Main Methods:
- Review of literature and clinical data on kidney transplantation outcomes.
- Analysis of donor characteristics and recipient selection strategies.
- Evaluation of allocation protocols for expanded criteria donor organs.
Main Results:
- Expanded criteria donors (defined by age, comorbidities, hemodynamic instability, non-heartbeating donation, seropositivity, infections, malignancy, abnormal organ function, or anatomical anomalies) provide a vital source of organs.
- While use of these kidneys increases organ availability, it also carries a higher risk of suboptimal recipient outcomes.
- Careful recipient selection and rational use of each donor kidney type are essential for acceptable results.
Conclusions:
- Kidneys from expanded criteria donors are crucial for meeting transplant demand.
- Successful transplantation requires a strategic approach to donor selection and recipient matching.
- Further research and optimized allocation systems are needed to maximize the benefit of expanded criteria donor kidneys.
Abstract:
There is a growing disparity between the demand for and the supply of kidneys for transplantation. The demographics of the donor pool are also changing. The average potential cadaveric organ donor is now more likely to be older, at greater risk for co-morbid conditions such as hypertension or viral infections, and more likely to die from cerebrovascular disease. These factors have led to an expansion of the criteria that defines the suitable organ donor. Expanded criteria donors are defined as the following: (1) at the upper and lower extremes in age; (2) having a history of hypertension or diabetes; (3) hemodynamically unstable; (4) non-heartbeating (cardiopulmonary death rather than brain death); (5) seropositive for hepatitis B or C; (6) having systemic infections; (7) having displayed high-risk social behavior for HIV infection; (8) having a history of malignancy; (9) having abnormal organ function; or (10) with renal anatomic anomalies or injuries. Use of kidneys from these "expanded criteria donors" is a two-edged sword. While they provide more organs for transplantation, the risk of suboptimal recipient outcome is increased. A rational approach to the use of each of these types of kidneys and proper selection of recipients is essential to obtain acceptable results. The article reviews the factors that have contributed to the successful transplantation of kidneys procured from expanded criteria organ donors and how these organs can be allocated most efficaciously to the appropriate recipients.