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Innovative Strategies for Organ Preservation in Heart Transplantation: Uniform Cooling Preservation and Ex-situ Normothermic Perfusion

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Published on: November 28, 2025

Optimizing outcomes by preconditioning the donor.

E Lledó-Garcia¹, D Subirá-Ríos, A Tejedor-Jorge

¹Urology Department & Experimental Urology Group, Hospital General Universitario Gregorio Marañón, Madrid, Spain.

Transplantation Proceedings

|February 22, 2011

Summary

Expanded criteria donor (ECD) kidneys, though associated with slightly lower outcomes, can expand organ availability. Careful donor selection and minimized ischemia are crucial for successful kidney transplantation.

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Area of Science:

Nephrology
Transplantation Surgery
Organ Donation

Background:

Standardized criteria for marginal donor kidneys exist since 2002, but transplant centers set individual organ acceptability guidelines.
Expanded criteria donor (ECD) kidneys are defined by age (≥60 years) or (50-59 years with ≥2 comorbidities).
Increasing organ donor shortages and waiting lists drive a rise in living donor kidney transplants in Europe.

Purpose of the Study:

To discuss the use of expanded criteria donor (ECD) kidneys in transplantation.
To highlight the importance of careful donor selection and management to optimize outcomes.
To address the challenges and considerations for utilizing older or comorbid deceased donors.

Main Methods:

Review of current definitions and criteria for expanded criteria donors (ECD).
Analysis of outcomes comparing cadaveric versus living donor kidneys.
Discussion on strategies to mitigate ischemia and improve kidney quality from deceased donors.

Main Results:

Kidneys from donors over 65 years yield 10-15% lower transplant outcomes than younger donors.
Older donors often have comorbidities, but acceptable results are achievable with careful selection and reduced cold ischemic times.
ECD kidneys, including those from older or cardiac death donors, represent a significant portion of deceased donor organs.

Conclusions:

Careful evaluation of ECD donors, considering age, vascular status, renal function, and comorbidities, is essential.
Minimizing ischemia and employing quality-improvement maneuvers are vital for utilizing ECD kidneys.
The decision to use ECD kidneys requires a comprehensive assessment beyond biopsy information alone.