FORUM Could More Effective Use of Kidneys Recovered from Older Deceased Donors Result in More Kidney Transplants for Older Patients? J. Michael Cecka, 1,4 Bernard Cohen, 2 John Rosendale, 3 and Mike Smith 2 In the face of a severe shortage of kidneys from deceased organ donors that limits access to transplantation for many patients, about one of every seven kidneys (more than 1,500 each year) recovered from deceased donors in the United States are not transplanted. Eurotransplant, which coordinates organ distribution for six countries and a population of about 118 million, discards only one of every 20 kidneys procured for transplantation. We compared kidney procure- ment, transplants, and discards between January 2000 and June 2003 in the United States and in the Eurotransplant region using the Organ Procurement and Transplantation Network/United Network for Organ Sharing and Eurotrans- plant databases to examine differences that might account for this wide disparity. Keywords: Kidney, Discard, Older Donor, Transplant. (Transplantation 2006;81: 966–970) T he worldwide shortage of deceased donor kidneys for transplantation and an increasing demand for trans- plants has fueled efforts to increase donation rates, to refine estimates of the number of potential donors, and to explore new potential sources of human kidneys for transplantation. Although donations increased substantially in the United States in 2004 (1), the number of kidneys available for trans- plants cannot meet the demand. During the past decade, ex- panding the criteria used for acceptance of deceased donors, particularly an increased use of older donor kidneys has in- creased the number of transplants (2). However, between 2000 and 2003, the United States discarded 37% of kidneys that were recovered from donors aged 61– 65 years and 54% of kidneys from donors over 65. Meanwhile, the lists of pa- tients who are waiting for a kidney transplant continue to grow each year. According to the United Network for Organ Sharing (UNOS) statistics for the United States in 2003, 23,805 patients were added to a waiting list that already num- bered more than 50,000, whereas only 8,664 kidneys from deceased donors were transplanted (www.unos.org). A sur- prisingly high percentage (12%) of these new candidates was older than age 65 years. For many of these older patients, the prolonged wait for a deceased donor kidney transplant means they will die or be too old for the surgery before a kidney becomes available. Nearly 10 patients died each day during 2003 (3,419 total, 728 patients over 65) while waiting for a kidney transplant. It is important that we question the reasons for discard- ing kidneys to be sure these could not be used to speed trans- plants for the older candidates. We examined the proportions of kidneys discarded in the United States and the reasons for discard and compared the results with those reported in the Eurotransplant region, where the institution of a “senior’s program” to direct older donor kidneys to older recipients has been successful in improving utilization of older donor kidneys. DATA SOURCES We compared deceased donor kidney procurement, transplantation, and discards between January 2000 and June 2003 in the United States and in the Eurotransplant region (Austria, Belgium, Germany, Luxemburg, the Netherlands and Slovenia; see www.eurotransplant.org). The analyses were limited to actual donors (donors from whom at least one organ was transplanted) to avoid the vagaries of what differ- ent organ procurement organizations might consider “po- tential” donors. The U.S. results were based on data reported to the Organ Procurement and Transplantation Network/ UNOS (OPTN/UNOS) as of November 25, 2003 and the Eurotransplant results were based on data reported through November 13, 2003. To assess the prevalence of pretransplant kidney biopsy in the United States, we examined the reported use for deceased donor kidneys transplanted during the same period. Statistical comparisons were made using chi-square 1 UCLA Immunogenetics Center, Department of Pathology, University of California at Los Angeles, Los Angeles, CA. 2 Eurotransplant Foundation, Leiden, the Netherlands. 3 United Network for Organ Sharing, Richmond, VA. 4 Address correspondence to: J. Michael Cecka, Ph.D., UCLA Immunogenet- ics Center, University of California Los Angeles, 1000 Veteran Ave 1-520, Los Angeles, CA. E-mail: mcecka@ucla.edu Received 14 September 2005. Accepted 15 November 2005. Copyright © 2006 by Lippincott Williams & Wilkins ISSN 0041-1337/06/8107-966 DOI: 10.1097/01.tp.0000216284.81604.d4 966 Transplantation • Volume 81, Number 7, April 15, 2006