Due to the increased demand in transplantable organs, the gap between kidney graft and supply
grows. The organ shortage continues despite the fact that surgeons have liberalized their acceptance criteria
for suitable deceased donor organs, have exploited the use of ABO-incompatible and marginal ‘expanded
criteria donors (ECD)’. However, kidneys from ECD donors come with their relative risk of graft failure of
1.7 compared with a reference group. Therefore, selection of kidneys from ECD donors remains extremely
important to guarantee an adequate kidney function and graft survival for long-term. Some ECD donor
kidneys are not accepted by many centers due to their extreme age and additional risk factors such as
hypertension, diabetes mellitus of the donor. A comprehensive assessment of the ECD kidney is mandatory
and long-term graft survival and kidney function need to be assured.
Keywords: Donor Selection, Expanded Criteria Donors, Marginal, Old, Old-to-old, Renal transplantation,
Single Transplant, Dual Transplant, Organ shortage, Kidney Biopsy, Renal Function.
