Undoubtedly solid organ transplantationremains the ultimate management of end-stageorgan failure. As an example, the treatment of choice for end-stagerenal disease is kidney transplantation.
The kidney is the commonesttransplanted organ with a long history of research. However, the number ofpatients who need kidney transplant is expanding quicker than the availabilityof organs. This imbalance between the supply and demand and the global shortageof donors is seen in other organs too. Accordingto thelatest UK transplant activity report (covering 2016 – 2017) the number ofpatients on the kidney transplant list currently is 5,233 whereas the number ofdeceased kidney donors was 1,336 and those from living donors was1,009 1.
Overall, for every lucky patient that receives a transplantedkidney, there are three to four more on the waiting list. According to the above-mentionedsource, the average waiting time for a kidney only transplant in the UKcurrently is 864 days for an adult patient. Lastly there are reports that up totwo patients die every day in the UK while waiting for a transplant sadlymaking it a “waiting to die” list 2 3. Similaris the situation in the USA. According to the United Network for organ sharingas of November 2017 there are 116,000 patients on the waiting lists with 96,000waiting for a kidney transplant.
4 As per the National Kidney Foundation, theaverage waiting time for an individual’s first kidney transplant is 3.6 yearsbut this obviously may vary depending on general health, compatibility and availabilityof organs. Also, each month more than 3,000 new patients are added to the kidney waiting list whichmakes it one every fourteen minutes and each day 13 people die while waiting.
Lastly of those waiting around4,000 become too ill to receive any transplant and are removed from the listeach year. 5 Thehuge pressure to compensate for the above shortage has led to intense researchin kidney transplantation. This has been largely focusing on use of marginalquality grafts. The idea is to expand the donor pool and at the same time tooptimize those grafts’ viability. To achieve the first, organs donated aftercardiac death (DCD) and expanded criteria donors (ECD) are currently extensivelyaccepted. Those include advanced age, other medical conditions such as HTN, CKDetc. In order to optimize those grafts’ viability new technologies are utilizedsuch as machine perfusion preservation, viability assessment and recondition.