Current Approaches for Marginal Donor Usage in Kidney Transplantation

Organ shortage is a significant problem for patients with end-stage renal disease seeking kidney transplantation despite efforts for increasing living kidney donation and strategies such as paired exchange. The donor pool can be expanded using more extended criteria donor (ECD) kidneys. Although graft survival in ECD transplants is shorter, these kidneys still provide a survival advantage over maintenance dialysis. The use of ECD kidneys is necessary to maintain current rates of transplantation. In United States, the Kidney Transplantation Committee is presented the United National Organ Sharing Board of Directors a document which calls for the allocation process to start by grading the kidney via a kidney donor profile index. Recently, major scientific societies related to renal transplantation in Spain have developed a consensus for the acceptance criteria of ECD kidneys and for the common actions to standardize access to transplantation with these donors nationwide. Herein, we aim to review the current strategies associated with marginal donor usage.