How long will I need to wait for a transplant?

That depends. The number of people waiting for a kidney transplant in October 2009 was 82,162. The number of kidney transplants from deceased donors performed this past year was 7,923 from January 1, 2009, through September 30, 2009.

Because of this large discrepancy between recipients and donors, ways to expand the donor pool are always sought. One way to expand the donor pool is to use living donors. From January 1, 2009, through September 30, 2009, there were 4,724 living donor kidney transplants performed in the United States. (More about living donors later.)

For many years only standard criteria donor kidneys were used for transplantation. A standard criteria donor kidney comes from a previously healthy individual between the age of 18 and 60 years of age who had an untimely death such as a motor vehicle accident. They were unable to survive their injuries and progressed to brain death. Their family made the generous offer to donate their organs.

Donation after cardiac death occurs when organs are donated from a patient on a ventilator who has severe brain injuries with no hope of meaningful recovery. Because of the futility of the patient’s prognosis, the family makes the decision to withdraw ventilatory support. If the family elects to donate the patient’s organs, the patient is taken to an operating room where the breathing tube is removed. If the patient’s heart stops beating within 20 minutes, the transplant team can remove the kidneys. Kidneys from donation after cardiac death donors have similar outcomes (last as long and work as well) as standard criteria donor kidneys.

Research has shown that many less commonly used donor kidneys (such as a kidney from a donor older than 60 years of age) can benefit carefully selected candidates. The goal is to expand the donor pool and thereby shorten the wait time for kidney transplantation. This group of donors is called expanded criteria donors.

Selected candidates include but are not limited to patients who are having difficulty with their dialysis treatments and patients who may face a shorter life expectancy while on dialysis.

Candidates must give their written consent before being listed for an expanded criteria kidney transplantation. The consent form is reviewed with the transplant nephrologist or transplant surgeon. Candidates who agree to receive expanded criteria donor kidneys are also eligible to receive standard criteria donor kidneys.

Expanded criteria donors are over 60 years of age or between 50 and 59 years of age with one of these criteria:

• CVA (stroke) + HTN (hypertension) + Creat (creatinine) > 1.5 at the time of kidney placement

• CVA + HTN

• CVA + Creat > 1.5 at the time of kidney placement

• HTN + Creat > 1.5 at the time of kidney placement

• CVA = CVA was cause of death

• HTN = history of hypertension at any time