Expanded criteria donor kidneys: evolution and current practice

Kidney transplantation is a well-established therapy for chronic renal failure, but its application is limited primarily by the availability of transplantable organs. The number of wait-listed patients continues to grow, and aggressive attempts to increase the numbers of transplants performed have failed to keep pace with demand. The continuing disparity between the demand for kidney transplants and the supply of organs has made efficient use of organs critical, forcing the transplant community to use organs from higher-risk donors than would previously have been considered. The precise definition of some marginal kidneys as expanded criteria donor kidneys was based on objective parameters and intended to expand the donor pool. This article reviews the development and definition of expanded criteria donor kidneys and the current strategies and outcomes associated with their use.