Expanded Criteria Donors (ECD)

The expanded criteria donor (ECD) is any donor over the age of 60, or a donor over the age of 50 with two of the following: a history of high blood pressure, a creatinine (blood test that shows kidney function) greater than or equal to 1.5, or death resulting from a stroke.

Sometimes the function of a single kidney from an expanded criteria donor organ would not be sufficient. In this situation, a pair of kidneys with limited function can be transplanted into a single patient. This type of transplant is called a dual kidney transplant. Research shows that this option offers outcomes that are just as good as a single-kidney transplant with normal function and can effectively address the shortage of donor organs.

The transplant center must get written permission from a patient before offering an ECD kidney. The decision to accept an ECD kidney is a personal decision. Accepting an ECD kidney may significantly decrease the amount of time a person waits for transplant. The ECD kidney comes with some risk for earlier graft loss but the exact risk is unknown. A good estimate is that 8 of 10 ECD kidneys will still be functioning at one year while 9 of 10 SCD kidneys will be functioning at one year.  At 5 years, half of ECD kidneys will still be functioning compared to 7 of 10 SCD kidneys. Studies have shown that transplant patients who receive either SCD or ECD kidneys have a superior survival when compared to remaining on dialysis.

The UC Davis Kidney Transplant Program leads Northern California in the use of ECD kidneys. Although it might be expected that the use of ECD kidneys might be associated with a higher rate of temporary dialysis after transplant or kidney loss, that is not the case. UC Davis also has the lowest rate of dialysis in the first week after transplant, and overall kidney survival statistics are excellent. This success may be partly related to the use of a perfusion pump in preserving kidneys. The pump mimics blood flow through the kidney and certain indicators can suggest whether a kidney will work well or not. The use of the pump provides the surgeon with one more piece of information to help decide whether or not to use a particular ECD kidney.  You should discuss whether to consent to ECD kidney offers with your nephrologist.