Double adult renal allografts

Abstract

D espite renewed efforts l’ocused on education of the public on the great disparity between the number of organ donors relative to the number of patients awaiting organ transplantation in the United States, the gap continues to increase. Currently, there are over 50,000 patient registrations on the United Network for Organ Sharing (UNOS) waiting list. Thirty-four thousand seven hundred sixty-six patients are awaiting kidney transplantation. It is estimated that 10 patients die each day awaiting transplantation. In 1996, there were 5,411 cadaveric organ donors. Although the waiting list size has increased approximately 20% per year, the cadaveric organ donor pool has only increased 4% per year. Median waiting times have nearly doubled for all organs in the last 6 years. From 1988 to 1995, cadaveric donors in the 18-34 age group decreased from 41% to 29%. During the same time period, the percentage of older donors (50 years) doubled from 12% to 24% and likely will continue to increase in prevalence as the population ages. Innovative strategies to compensate for this major constraint to kidney transplantation provided the impetus to conduct a protocol for the use of kidneys from older donors with suboptimal nephron mass, kidneys that otherwise might not have been used for transplantation. The protocol was initiated in 1994 and entailed the simultaneous transplantation of both kidneys from a single donor into a recipient. The background for this novel approach was based on several elegant