How to identify the best candidates for kidney transplantation: protocols for making the best use of scarce donor organs.

Potential kidney transplant recipients must be thoroughly evaluated to ensure that scarce donor organs are used appropriately. Begin by determining the cause of renal failure (some diseases can recur in transplanted organs; others are associated with increased post-transplant morbidity and mortality). Cancer, active infection, some forms of thrombosis and atherosclerosis, and patient noncompliance usually contraindicate kidney transplantation. A careful patient assessment can identify other factors that may increase the risks of significant postoperative complications; however, most of these factors can be modified before proceeding with transplantation.