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Updated: Jun 20, 2026
Murine Kidney Transplant Technique
Published on: October 20, 2015
Marginal kidney donor
Ganesh Gopalakrishnan1, Siva Prasad Gourabathini
1Department of Urology, Christian Medical College, Vellore, India.
Abstract:
Renal transplantation is the treatment of choice for a medically eligible patient with end stage renal disease. The number of renal transplants has increased rapidly over the last two decades. However, the demand for organs has increased even more. This disparity between the availability of organs and waitlisted patients for transplants has forced many transplant centers across the world to use marginal kidneys and donors. We performed a Medline search to establish the current status of marginal kidney donors in the world. Transplant programs using marginal deceased renal grafts is well established. The focus is now on efforts to improve their results. Utilization of non-heart-beating donors is still in a plateau phase and comprises a minor percentage of deceased donations. The main concern is primary non-function of the renal graft apart from legal and ethical issues. Transplants with living donors outnumbered cadaveric transplants at many centers in the last decade. There has been an increased use of marginal living kidney donors with some acceptable medical risks. Our primary concern is the safety of the living donor. There is not enough scientific data available to quantify the risks involved for such donation. The definition of marginal living donor is still not clear and there are no uniform recommendations. The decision must be tailored to each donor who in turn should be actively involved at all levels of the decision-making process. In the current circumstances, our responsibility is very crucial in making decisions for either accepting or rejecting a marginal living donor.
Insights
Marginal kidney donors are increasingly used in renal transplantation due to organ shortages. Further research is needed to ensure donor safety and establish clear guidelines for using these marginal kidney donors.
Area of Science:
- Nephrology
- Transplantation Surgery
- Medical Ethics
Background:
- End-stage renal disease (ESRD) necessitates renal transplantation as the primary treatment.
- A significant disparity exists between organ availability and the growing number of patients awaiting transplants.
- This organ shortage compels transplant centers globally to consider marginal kidneys and donors.
Purpose of the Study:
- To review the current global status of marginal kidney donors.
- To assess the utilization and outcomes of marginal deceased and living kidney donors.
- To highlight concerns regarding donor safety and the lack of standardized guidelines.
Main Methods:
- A Medline search was conducted to gather data on the use of marginal kidney donors worldwide.
- Analysis of existing transplant programs utilizing marginal deceased renal grafts.
- Review of trends in living donor kidney transplantation, including the use of marginal living donors.
Main Results:
- Transplant programs using marginal deceased renal grafts are established, with ongoing efforts to improve outcomes.
- Utilization of non-heart-beating donors remains limited, comprising a small fraction of deceased donations.
- Marginal living kidney donors are increasingly used, despite concerns about donor safety and insufficient data on associated risks.
Conclusions:
- The definition and criteria for marginal living donors are unclear, lacking uniform recommendations.
- Decisions regarding marginal living donors require individual assessment and active donor involvement.
- There is a critical need for more scientific data to quantify risks and establish clear guidelines for marginal living donor transplantation.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure
01:16Kidney Transplant III: Nursing Management