In utilizing older or expanded criteria donors (ECD), transplant centers must weigh the benefits of increasing the supply of available organs against the potential risks of using marginal organs. In recent years, European countries and the United States (US) are utilizing older deceased donors in increasing proportions. We hypothesized that that the increased use of older donors are a primary driver of increases in deceased donation rates and the successful use of older donors in Spain have been replicated in the US, Eurotransplant, and United Kingdom (UK). Deceased donor data from Spain, the US, Eurotransplant, and UK from 1999-2009 were assessed for the relative shifts in the deceased donor characteristics for donor age, donation rate, and corresponding recipient graft survival rate. Deceased donation rates have increased in each of the regions studied, with the largest donation rate increases for donors 45-60 years and over 60 years. Similarly, the graft survival rate for kidney and liver recipients has increased, with the largest increases in donors 45-60 years and over 60 years. The use of ECD is more widespread, and older donors increase the organ supply while providing similar recipient outcomes.

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