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Expanded Criteria Donors
1From the Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Insights
Expanded criteria donor kidneys, while having uncertain risks, can significantly reduce transplant wait times. Transplant recipients show higher survival rates compared to those on the waitlist, especially with perfusion pump use.
Area of Science:
- Nephrology and Transplant Surgery
- Organ Donation and Transplantation
Background:
- Expanded criteria donors (ECD) are defined by age (>60) or younger donors (>50) with specific risk factors (hypertension, elevated creatinine, stroke death).
- Utilizing ECD kidneys can shorten transplant waiting lists but requires informed consent due to potentially shorter graft survival.
- The exact risks associated with ECD kidneys are not fully understood, though outcomes are generally less predictable than standard criteria donors.
Purpose of the Study:
- To evaluate the outcomes and viability of using expanded criteria donor kidneys in transplantation.
- To explore strategies for maximizing the utilization of the donor organ pool, including dual-kidney transplantation.
- To assess the role of perfusion pump technology in assessing and preserving ECD kidneys.
Main Methods:
- Analysis of outcomes for recipients of expanded criteria donor kidneys compared to standard criteria donors and waitlisted candidates.
- Investigation into the use of dual-kidney transplantation for ECD organs with insufficient single-kidney function.
- Assessment of the impact of perfusion pump preservation on ECD kidney viability and clinical decision-making.
Main Results:
- At 5-year follow-up, 50% of expanded criteria donor kidneys remain functional.
- Transplant recipients, regardless of donor type, demonstrate superior survival rates compared to waitlisted patients.
- Dual-kidney transplantation with ECD organs provides outcomes comparable to single-kidney transplants with normal function.
Conclusions:
- Expanded criteria donor kidneys offer a viable option to increase organ availability and improve transplant recipient survival.
- Perfusion pump technology aids in the assessment and selection of ECD kidneys, potentially increasing success rates.
- Meticulous donor selection and advanced surgical techniques, including dual transplantation, can effectively expand the donor pool and address organ shortages.
Abstract:
The expanded criteria donor is any donor over the age of 60 years or a donor over the age of 50 years with 2 of the following 3 items: (1) history of high blood pressure, (2) serum creatinine ≥1.5 mg/dL, and (3) death due to stroke. To accept an expanded criteria donor kidney may significantly decrease the amount of time a person waits for transplant but requires written informed consent from the recipient. Although expanded criteria donor kidneys have predictably shorter outcomes than standard criteria donors, the exact risk is unknown. At 5 years follow-up, 50% of expanded criteria donor kidneys are still working. Regardless of donor status of these kidneys as expanded criteria or standard criteria, the transplant recipients have higher survival rates compared with candidates who remain on the wait list. The success rate may be increased when a perfusion pump is used to preserve the kidneys. Sometimes the function of a single kidney from an expanded criteria donor is deemed insufficient. In this situation, a pair of marginally functioning kidneys may be transplanted as a dual-kidney transplant. This dual transplant option offers acceptable outcomes as good as a single-kidney transplant with normal function and can effectively address the shortage of donor organs. The use of a perfusion pump allows the clinician to decide whether or not to use a particular expanded criteria donor kidney. Expanded criteria donors may be justified by meticulous selection of each donor for recipients, along with more sophisticated surgical techniques to maximize the kidney donor pool.
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