title: Optimizing clinical utilization and allocation of older kidneys.
abstract: OBJECTIVE
  With a persisting organ shortage and constant high discard rates, there is an urgent need to optimize the outcome and allocation of marginal grafts.
  
  
  RESULTS
  The Eurotransplant Senior Program was established as an 'old-for-old' allocation system emphasizing on the importance of keeping ischemic times short when utilizing marginal grafts. In addition to refined allocation systems, brief cold ischemic times, novel preservation techniques, a careful assessment of organ quality the utilization of dual kidney transplantation and donation after cardiac death kidneys from elderly donors may all help to increase the supply for renal transplantation. Moreover, age-adapted immunosuppression, improved patient selection and preparation for transplantation may help in improving outcomes when using marginal kidneys.
  
  
  CONCLUSIONS
  There is a significant potential to increase the utilization of marginal grafts with reduced discard rates, an increased utilization of dual kidney transplantation and the application of novel preservation methods.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charite Virchow Clinic, Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Denecke
authors.forename: Matthias
authors.initials: M
authors.lastname: Biebl
authors.forename: Johann
authors.initials: J
authors.lastname: Pratschke
mesh_terms: D000375:Aging; D006801:Humans; D007668:Kidney / Q000502:physiology*; D016030:Kidney Transplantation; D009926:Organ Preservation; D018579:Patient Selection; D014019:Tissue Donors / Q000600:supply & distribution