Deceased Donor Kidney Allocation: What Is the Next Step?

Outcomes of kidney transplants and the rate of deterioration in posttransplant kidney function in the United States have improved in recent years. This news provides optimism to patients awaiting transplants, their caregivers, and their families, as well as the assurance that they are waiting for a transplant that has a durable lifespan and function. These gains are particularly tied to advances in patient selection and medical management of the many complexities posed by renal transplantation.

Extended criteria donor kidneys (ECDs) may afford timely transplantation to patients with a high expected waitlist mortality, who could benefit from shorter wait times. But the ECD listing practices prevailing in the United States have thus far fallen short of promises. Jesse Schold outlines a general guideline for rational use of ECD organs that would benefit those most in need of short waiting times.

The ranks of patients waiting for a kidney transplant are being swelled by recipients of prior liver, heart, and lung transplant recipients with renal failure. The rate of growth of this population is much greater than the growth of the kidney-alone waitlist. The challenges posed by this emerging population, especially in the ethical domain, are addressed by David Goldfarb.

Adolescent transplant recipients transitioning to adulthood pose several medical and psychosocial challenges. Charles Kwon and Julie Corder look at this issue using a patient vignette as a backdrop.