Kidney Transplantation from Expanded Criteria Donor in Korea: It's Time to Have Our Own Criteria Based on Our Experiences

Shin-Seok Yang; Jae Berm Park

doi:10.4285/jkstn.2017.31.1.16

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Yang and Park: Kidney Transplantation from Expanded Criteria Donor in Korea: It's Time to Have Our Own Criteria Based on Our Experiences

Review Article

The Journal of the Korean Society for Transplantation 2017; 31(1): 16-24.

Published online: 30 March 2017

DOI: https://doi.org/10.4285/jkstn.2017.31.1.16

Kidney Transplantation from Expanded Criteria Donor in Korea: It's Time to Have Our Own Criteria Based on Our Experiences

Shin-Seok Yang, M.D.¹, Jae Berm Park, M.D.²

¹Division of Transplantation and Vascular Surgery, Yeungnam University Medical Center, Yeungnam University School of Medicine, Daegu, Korea.

²Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Corresponding author: Jae Berm Park. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea. Tel: 82-2-3410-3647, Fax: 82-2-3410-0040, jbparkmd@gmail.com

Received 18 February 2017 Accepted 22 February 2017

Abstract

The disparity between the number of patients awaiting kidney transplantation (KT) on the list and the number of actual number of KT from deceased organ donation has become wider despite the recent increase in the number of donations. Moreover, the proportion of donors aged 60 or more has rapidly increased. KT from expanded criteria donor (ECD) has been not only been necessary, but also inevitable with respect to maximizing the use of this scarce organ resource. However, we still use the “marginal donor criteria” implemented in 2000 when KONOS (Korean Network for Organ Sharing) was established. In the Korean transplantation environment, this “marginal donor criteria” does not have the power to predict graft outcome, and fails to discern grafts with inferior transplant outcomes from successful transplants. As a result, it does not meet the role of the criteria in Korea. Therefore, we should develop our own criteria based on our deceased donor kidney transplantation experience. Here, we review the current status of ECD KT in Korea in context with the progression of the ECD criteria system in UNOS (United Network for Organ Sharing) and present some considerations for the Korean donor criteria system.

Keywords: Kidney transplantation, Brain death, Donor, Standards, Allografts

Figures and Tables

Fig. 1

Deceased donor in Korea. (A) Number of deceased donor according to age, (B) Proportion of donor age over or equal to 60 years. Adapted from reference [2].

Fig. 2

Graft survival of DDKT according to donor criteria. Abbreviations: DDKT, deceased donor kidney transplantation; ECD, expanded criteria donor; SCD, standard criteria donor. Adapted from reference [unpublished data]. Data of DDKT donors and recipients between Feb 1995 and Dec 2014 from Samsung Medical Center, Seoul National University Hospital and Yonsei University Medical Center Severance Hospital, Unpublished data.

Table 1

Donor criteria

Abbreviations: KONOS, Korean Network for Organ Sharing; UNOS, United Network for Organ Sharing; OPTN, Organ Procurement and Transplantation Network.

^aAdapted from reference [7].

^bAdapted from reference [8] (OPTN Policy 3.5.1 effective between 31 Oct 2002∼Nov 2014).

Table 2

Criteria for dual kidney transplantation

Abbreviations: KONOS, Korean Network for Organ Sharing; UNOS, United Network for Organ Sharing.

^aAdapted from reference [8].

^bAdapted from reference [19].

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