The use of expanded criteria donor organs for transplantation

Expanded criteria donors (ECD) of kidneys include all those aged ≥60 years and donors aged 50–59 years with at least 2 of the following 3 medical criteria: (1) cerebrovascular accident as the cause of death, (2) terminal serum creatinine concentration >1.5 mg/dL, and (3) history of systemic hypertension. ECD kidneys now account for 20% of all deceased donor kidneys in the United States, with the fraction being as high as 35% in some donation service areas. However, procured ECD kidneys continue to be discarded at a significantly higher rate (41%) compared with 8% for non-ECD kidneys. Patients who elect to be offered and receive ECD kidneys have survival benefits of decreased long-term mortality between 17% and 27% when compared to waiting longer and subsequently receiving an standard criteria donors organ, but only if the waiting time is more than 44 months. The experience with ECD kidneys in the United States suggests that organ donation and transplantation rates can be significantly improved through the systematic incorporation of ECD policies into organ procurement and transplantation schemes. More refined definition of ECD and rigorous assessment of the outcomes of ECD organ transplantation will further contribute to improving the use of all donated organs.