Utilization of extended criteria donors

PURPOSE OF REVIEW: Recent figures show 100 000 patients awaiting transplant in our country. Meanwhile, 30 000 organ transplants will be performed in 2006. Donor organ scarcity dictates that most who wait must continue to do so. Attempts are ongoing to expand the donor pool by extending the criteria by which a donor is deemed appropriate. The purpose of this review is to examine those efforts in liver, kidney, and pancreas transplantation and highlight recently published advances. RECENT FINDINGS: Studies are focusing on defining and stratifying the risk associated with an extended criteria donor. The fields of hepatic, renal, and pancreatic transplantation each attempt to show that acceptable outcomes are maintained when extended criteria donors are utilized in appropriate circumstances. Donation after cardiac death has emerged as one possible avenue though overall numbers remain small and increased recipient complications are evident. SUMMARY: In summary, considerations differ when a physician and patient consider whether to accept a liver, kidney, or pancreas from a donor that has been determined to be suboptimal. Quantifying the additional risk accrued and contrasting it to that posed by staying on the waitlist are ongoing challenges as we attempt to maximize results in organ transplantation with extended criteria donors.