Expanded-criteria donors: an emerging source of kidneys to alleviate the organ shortage

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Purpose of review

As the size and the number of deaths on the recipient waiting list increase, kidneys from older donors and donors with characteristics once thought to preclude organ donation are being used more frequently. Recent reports have demonstrated that recipients of expanded-criteria kidneys receive the benefit of extra life-years compared with wait-listed dialysis patients.

Recent findings

The designation of expanded-criteria kidneys has been defined using statistical risk factors that result in diminished graft survival. These factors are primarily donor age older than 60 years, or more than 50 years with death from cerebrovascular accident; creatinine greater than 1.5 mg/dl at death; or preexisting hypertension. In addition, kidneys from donors previously thought marginal such as donation after cardiac death, dual transplants, ‘old-for-old’ combinations, pediatric en-bloc transplants, infected donors or donors with toxins, and ABO-incompatible transplants have opened up sources of kidneys for more waiting patients.


Expanded-criteria organ donation is emerging as a safe practice that helps to meet the shortage of kidneys available for transplantation. Careful selection and adequate knowledge of the risk factors involved in expanded-criteria donation and informed consent of donors and recipients are essential before deciding between accepting and declining marginal kidneys for transplantation.

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