The use of marginal-suboptimal donor organs: a practical solution for organ shortage.

The demand for organ transplantation has been rapidly increasing as a result of rising incidence of end-stage organ failure while the supply of cadaver organs from "ideal" or optimal donors has remained low and inadequate to meet the increasing demand. Yet many so called "marginal" or "suboptimal" organs have been discarded by many centers when many patients die each day while on the waiting list. In this review important data from our experience and that of several other centers have confirmed that using such marginal organs can provide a viable solution to organ shortage. Such organs include those from donors > 55 years, children < 5 years, diabetics, non-heart beating cadavers, and organs with extended preservation. Such organs can be successfully used with appropriate surgical techniques and immunosuppression protocols and the supply of donor organs can be increased by 25% to 30%.