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Updated: Jun 17, 2025
Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation
Published on: July 15, 2015
Allocation Rules and Age-Dependent Waiting Times for Kidney Transplantation
Benedikt Kolbrink1, Nassim Kakavand, Jakob C Voran
1Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany; Department of Internal Medicine III, Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Germany; Peter L. Reichertz Institute for Medical Informatics (PLTI), TU Braunschweig and Hannover Medical School, Hannover, Germany; German Organ Procurement Organization (DSO), Frankfurt am Main, Germany; Eurotransplant International Foundation, Leiden,Netherlands; Institute of Ethics and History of Medicine, University Medicine Göttingen, Göttingen, Germany; Division of Clinical Transplantation Medicine, Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Hospital Schleswig Holstein Campus Kiel, Kiel, Germany.
Background:
Rigid age limits in the current allocation system for post-mortem donor kidneys in Germany may have problematic effects. The new German national transplantion registry enables data analysis with respect to this question.
Methods:
Using anonymized data from the German national transplantion registry, we extracted and evaluated information on the recipients and postmortem donors of kidneys that were allocated in Germany through Eurotransplant over the period 2006-2020.
Results:
Data on 19 664 kidney transplantations in Germany from 2006 to 2020 were analyzed. The median waiting time for kidney transplantation was 5.8 years. Persons under age 18 waited a median of 1.7 years; persons aged 18 to 64, 7.0 years; and persons aged 65 and older, 3.8 years. Over the period of observation, postmortem kidneys were transplanted into 401 people of age 64 (2.0% of all organ recipients) and 1,393 people of age 65 (7.1% of all organ recipients). The difference in waiting times between allocation programs for persons under age 65 (ETKAS, "Eurotransplant Kidney Allocation System") and those aged 65 and older (ESP, "Eurotransplant Senior Program") increased over the period of observation, from 2.6 years in 2006-2010 to 4.1 years in 2017-2020.
Conclusion:
The rigid age limits in the current allocation rules for post-mortem kidney donations in Germany are prolonging the waiting times for transplants among patients aged 18 to 64. We think these rules need to be fundamentally reassessed.
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