Expanding the donor pool.

Advances in techniques and the development of new immunosuppressive drugs have made it possible to transplant a large number of patients throughout the world. However, the shortage of cadaveric organ donors remains the major obstacle for the full development of organ transplantation, imposing a severe limit to the number of patients who could benefit from this therapy. Although transplants save thousands of lives and transform the quality of life of thousands more, many people will die or remain on renal replacement therapy because the organ supply falls drastically short of actual demand. In the US, the number of organ donors has increased approximately 20% over the past 5 years, but this increase has been brought about largely by the use of older donors and other donors considered by some to be marginal. In the 6 years from 1988 to 1994, the waiting list for kidneys grew by 76% in the US. By the end of August 1996, there were 33,339 patients registered for kidneys on the national transplant waiting list. This report examines the issue of the elderly donor, the role of living-unrelated kidney transplantation, and proposes various strategies to enhance procurement of cadaver kidneys.