Contemporary criteria for cadaveric organ donation in renal transplantation: the need for better selection parameters

A major problem facing transplantation is the disparity between the availability of cadaver donors and the number of recipients awaiting transplantation. Efforts to deal with this issue have involved the use of "marginal donors." Results obtained using these organs have often been significantly worse at 1 and 3 years of follow-up. The problem of how to select and utilize these donors is of critical importance to both patients and society. Current criteria available for assessing cadaver donors are based on ideal donors. Although these appear adequate for predicting the results for the ideal donor, they are not adequate for assessing results for marginal donors. New criteria are of critical importance for better utilization of these organs. The purpose of this review is to examine the current criteria for ideal and marginal donors, review the critical issues to be clarified, and discuss options for improvement results in the future.