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  • Review Article
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Increasing the pool of deceased donor organs for kidney transplantation

Nature Reviews Nephrology volume 8, pages 325–331 (2012)Cite this article

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Abstract

Expanding the pool of available deceased donor kidneys is critical for improving the outcomes of prospective and current renal transplant candidates. A number of interventions have been proposed that may increase the pool of donors in the US. However, these interventions have variable levels of empirical evidence supporting their potential beneficial impact. Proposed interventions include the instigation of policies for presumed donor consent, the expansion of donor registration, increased quality oversight of transplant providers, financial incentives for donors, increased reimbursement for higher risk donors, alterations in organ allocation policies and distribution, and the selective use of donors with potential or known risk for disease transmission. Many of these interventions have contentious elements that may have delayed or impeded their implementation; however, these options should be considered in the context of the diminishing prognoses for prospective transplant patients, given the increasing scarcity of donor organs relative to the population need. In this Review, we outline the proposed interventions and briefly discuss salient issues that characterize the debates concerning their implementation and effectiveness. Ultimately, any intervention must be based on the best evidence available, with consideration of numerous stakeholders and in conjunction with a careful evaluation of long-term and potential unintended consequences.

Key Points

  • An attenuation in the growth of deceased donor kidney transplantation has occurred in the US over the past few years

  • A critical opportunity for increasing transplantation rates is to increase the pool of available deceased donor kidneys

  • Interventions that may increase the deceased donor pool include: presumed donor consent policies, financial incentives for donors, alterations in organ allocation policies, and selective use of donors with risk for disease transmission

  • Although each of the proposed interventions has some contentious elements, they should be placed in the context of the declining prognoses of patients waiting for transplants in the setting of a growing scarcity of available organs

  • Ultimately, a systems approach that incorporates multiple interventions may be the most effective way to increase the donor pool

  • The implementation of any intervention should carefully consider multiple stakeholders and potential long-term and unintended consequences

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Authors and Affiliations

  1. Department of Quantitative Health Sciences, JJN3-01, 9500 Euclid Avenue, Cleveland Clinic, Cleveland, 44195, OH, USA

    Jesse D. Schold

  2. Department of Surgery, Johns Hopkins University, School of Medicine, Harvey 611, 600 North Wolfe Street, Baltimore, 21287, MD, USA

    Dorry L. Segev

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The authors contributed equally to all aspects of this article.

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Correspondence to Jesse D. Schold.

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Schold, J., Segev, D. Increasing the pool of deceased donor organs for kidney transplantation. Nat Rev Nephrol 8, 325–331 (2012). https://doi.org/10.1038/nrneph.2012.60

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