How am I selected for a kidney from a deceased donor?

The current kidney allocation policy considers characteristics of both the donor and the transplant candidate in allocating kidneys fairly, efficiently and effectively. A combination of factors, working together, determines who receives which organ. These factors include:

  • Length of time spent on the waiting list
  • Whether the potential organ candidate is a child
  • Tissue match between donor and candidate
  • Body size of both donor and candidate
  • Blood type
  • Blood antibody levels

Although the kidneys that are most commonly transplanted come from previously healthy donors between age 18 and 60, kidneys from other donors with a wide range of characteristics have been successfully transplanted. Donor age has ranged from newborn to nearly 80, and medical histories of donors sometimes include such conditions as diabetes or high blood pressure.

Research has shown that many less-commonly used donor kidneys (such as a kidney from a donor older than age 60) can help dialysis patients who are at a greater risk of problems (including death) while waiting for a transplant. Therefore, it makes sense to offer those kidneys to people who would benefit from them most. The current policy does this by defining kidneys that meet expanded criteria and offering them only to patients who agree to accept them.

Because the number of people waiting for a kidney is at an unprecedented high – more than 75,000 people are waiting for a kidney in the United States – you will be asked whether or not you want to participate in the Expanded Donor Policy. You will need to decide this before your name is placed on the UNOS waiting list.

This means you may receive a kidney from a “less than traditional donor.” Deceased donors that fall into the less traditional category are defined as those:

  • Age 60 or older
  • Between age 50-59 with at least two of the following conditions:
    •  History of high blood pressure
    •  Creatinine level of greater than 1.5 (A creatinine test measures how well a kidney is functioning. Normal range is 0.8 – 1.4.)
    •  Cause of death was from a stroke or aneurysm

Remember, the fact that you are being considered for this category of organ does not mean that you would only be considered for these types of organ offers. You would also remain on the waiting list for standard kidney offers.

Some patients do well on dialysis for extended periods of time. Others don’t do as well. Some patients may face an increased risk of serious complications, even death, if they continue to wait on the list year after year. By agreeing to be considered for a kidney that falls outside the standard criteria (age 49 and less), you may not have to wait as long for your transplant. However, there is a greater chance that your donor kidney may not function as well or as long.

It is important that you discuss your individual situation with us. Some factors you may want to discuss with a doctor include:

  • Problems you may be having with your dialysis treatment
  • Whether or not you may face a shorter life expectancy while on dialysis
  • If you are likely to suffer major complications while on long-term dialysis


Haisch, Carl E., MD
Harland, Robert C., MD
Morgan, Claire, MD