Deceased donors

Deceased donors are individuals who have irreversibly lost all brain function.  This may occur after an injury such as a fall, motor vehicle accident or a stroke. The determination of irreversibility, as well as the determination that all brain function is not present, are only made after repeated, confirmatory testing over a prolonged period of time.  Only then are the organs from a deceased donor retrieved by a surgical team. 

Kidney transplants obtained from deceased donors function almost as well as those obtained from living donors.   Based on our most recent data analysis, approximately 94 percent and 91 percent are functioning successfully at one and three years.  Recipient survival is 96 percent and 94 percent at one and three years.

Potential recipients are identified through the UNOS (United Network for Organ Sharing, www.unos.org) waiting list. The recipients are ranked by UNOS using a point system, which calculates a number of factors, including degree of match between the potential recipient and donor and the length of time potential recipients have been on the waiting list.

Historically, an ideal deceased donor was considered to be: (1) young, i.e. between 10 and 39 years old, (2) had no medical conditions known to effect their kidneys, including hypertension, (3) had a normal serum creatinine and normal kidney function, and (4) had no condition, e.g. an infection or malignancy, that could be transmitted to the recipient through the act of organ donation.  However, in each of the past few years, for every patient who receives a kidney transplant, four remain on the UNOS waiting list.  This mismatch between those waiting and the number of available, transplantable kidneys has prompted the transplant community to review outcomes using all donors. 

Expanded criteria donor kidneys are obtained from donors who are 50 years old or older and who have any two of the following (a) a terminal creatinine > 1.5 mg/dl, (b) a stroke as the cause of death, and (c) a history of hypertension.  In addition, all donors 60 years and older are considered expanded donors.  From the start, recipients of kidneys obtained from expanded donors were found to have a greater risk of transplant failure when compared to the ‘ideal’ reference group.  In reality, the functional success rate for expanded criteria donor kidneys is excellent.  In our experience, over 90 percent of our deceased donor kidneys and at least 85 percent of the expanded criteria donor kidneys will be functioning after three years.  In fact we take the selection process a step further and biopsy each kidney that we plan to use from an expanded criteria donor to make sure that it has the highest likelihood of functioning.  We discard expanded criteria donor kidneys when the biopsy does not appear favorable. 

We offer expanded criteria donor kidneys to some, but not all patients.  This is because receiving a transplant using an expanded criteria donor kidney provides a clear advantage for those selected patients when compared to remaining on dialysis.  During pre-transplant orientation, patients are asked to indicate whether or not they are interested in receiving a kidney from an expanded donor and patients are informed prior to transplant if the kidney they are being offered is from an expanded donor.