ARTICLE: Improving the Supply and Quality of Deceased-Donor Organs for Transplantation

AUTHORS: Stefan G. Tullius and Hamid Rabb

JOURNAL: N Engl J Med. 2018 May 17;378(20):1920-1929. doi: 10.1056/NEJMra1507080.


Organ transplantation is the treatment of choice for many patients with end-stage diseases, but the supply of organs that are considered acceptable according to current criteria is limited. Approaches to reducing the increasing gap between demand for and availability of donated organs have focused mainly on ways to increase rates of donation both from living donors and from deceased donors. However, a largely untapped opportunity is provided by the substantial number of deceased-donor kidneys and other solid organs that are now discarded because of quality that is considered suboptimal. Such organs are currently not used because of donor factors such as older age, hepatitis C virus (HCV) infection, and cardiac death. However, new approaches and treatments have been developed that permit the successful transplantation of deceased-donor organs that were previously considered unusable.

In this review, we focus on organs that were generally not accepted for transplantation in the past because of donor risk factors or other concerns. We also discuss novel biologic and bioengineering principles to improve organ selection and use. Since most of the available data pertain to kidney transplants, we focus on the kidney but also highlight aspects that are relevant to other organs.

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