Live donation of a deceased donor's kidney

Kidney retransplantation-the reuse of a previously transplanted allograft-is rare, although limited reports suggest clinical feasibility and an underrecognized opportunity within the existing donor pool. We present a novel case involving a living individual donating a previously transplanted deceased donor kidney after early graft failure from recurrent focal segmental glomerulosclerosis. Five days later, that kidney was transplanted into a second recipient, where it has continued to function for over 8 years. This case report also exposed structural barriers that limit broader adoption. The current system lacks standardized mechanisms to identify appropriate allografts for regifting. Even when identified, accurate characterization requires attributing the graft to the original donor's profile rather than the interim recipient's, while also accounting for cumulative calcineurin inhibitor exposure and the interim recipient's clinical course. Most consequentially, the interim donor in this case report met criteria for neither living nor deceased donation, leaving him unclassifiable under either existing donor framework. These findings underscored gaps in donor classification, data capture, and organ allocation that constrain wider implementation of allograft reuse. Addressing these gaps represents a unique opportunity to expand the donor pool without requiring a single additional donor.