Marginal kidneys for transplantation

Transplant waiting lists are growing in most developed countries, along with the need to increase the supply of organs donated after death. Increasing the age of eligible donors and thus reducing the “quality” criteria for donated kidneys may be one answer to the mismatch between supply and demand, opening up the possibility of donation for older donors with significant comorbidities. In a population based cohort study (doi:10.1136/bmj.h3557), Olivier and colleagues used data from four renal transplant programmes in France to examine the long term outcomes of transplantation using kidneys from expanded criteria donors (ECD).1

The authors classify expanded criteria organs as coming from donors older than 60 years or older than 50 years with associated vascular comorbidities.2 In the United States, ECD represent fewer than 20% of donors, from whom 40% of retrieved kidneys are not even transplanted; but in France, these donors provide 47% of kidney transplants. It is clear that kidneys from expanded criteria donors are associated with worse outcomes than are kidneys from standard criteria donors (SCD), including reduced graft and patient survival.3 The fairness of allocation principles for …