Expanding the living related donor pool in renal transplantation: Use of marginal donors

Purpose: In a living related transplantation program it is not always possi ble to find an ideal donor. Sometimes the only available donor in the famil y has some benign disease or suboptimal renal anatomy or physiology, or is too old to be accepted and defined as a marginal donor. However, with prope r screening the donor pool can be increased by accepting these marginal don ors and treating the benign diseases which is beneficial to the donor. We e valuate the outcome of grafts from marginal donors. Materials and Methods: From July 1988 to August 1997, 581 live related tran splantations were performed. Of the donors 52 were older than 60 years and 34 had associated benign renal or nonrenal anomaly or disease. These donors were accepted after thorough questioning and consultation with family memb ers. The recipients of graft from elderly donors were evaluated for the num ber of rejections, serum creatinine at last followup and graft survival. Results: Of the recipients 52 received grafts from elderly donors with a me an age of 62.6 +/- 3.7 years. Mean followup was 34.14 +/- 0.7 months. The 2 and 5-year actuarial graft survival was 96% and 74%, respectively. Creatin ine was normal (less than 1.5) in 37% of recipients and 1.5 to 2.5 mg.% in 46%. The rejection rate in postoperative month 1 was 29%. All donors underw ent simultaneous surgery to treat the benign disease, and all did well afte r surgery. Conclusions: By accepting these marginal donors a 14.6% increase in the liv ing related donor pool was achieved without compromising recipient or donor safety. Otherwise these recipients would have been forced to undergo unrel ated transplantation or be maintained on dialysis, which is particularly di fficult in a developing country. Donors with associated disease benefited f rom cure.