The excellent results in terms of patient survival and quality of life after solid organ transplantation reflect the improvements made in donor and recipient selection and management and in surgical technique in the past 30 years. Losing the graft or the patient for a poor selection of the recipient or for a technical mistake has become less and less frequent due to the thorough candidate preoperative evaluation and the established surgical technique. The attention has shifted to the selection of the donor as one of the most important variables in the outcome of the transplanted patient and as the most immediate way of filling the gap between the number of available organs and the number of patients waiting for transplantation.

The "ideal donor" is a fluid concept especially nowadays with the transplant community struggling with the organ shortage and stretching the acceptance criteria. Even when applying the concept of the "suitable donor", aside from few absolute contraindications, it is a challenge to define strict guidelines. As a result, experience and wisdom come to play a very important role in the selection of the donor. The present trend of accepting donor candidates, who at the beginning of this decade were refused at the screening phone call, reflects some of the lessons learned with the use of the so-called "marginal donors" and the persistent paucity of donors. In the future, if the number of donations increases, and if xenotransplantation becomes a viable option, it probably will be feasible to draw strict guidelines to better characterize the "ideal donor".

Organ Procurement and Preservation, edited by Goran B. Klintmalm and Marlon F. Levy. © 1999 Landes Bioscience

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