Priority Should be Given to Centers that Split En Bloc Pediatric Kidneys to Maximize Transplantation: A Single Center Experience

The foundation for OPTN policy 8.5.B that allows for en bloc kidney utilization from pediatric donors under <18 kg is unclear. Naturally, kidneys recovered from these donors can be split and transplanted into 2 adult recipients as opposed to only 1 (OPTN policy 8.5.C). Our center universally splits all pediatric donor kidneys. We showed that early eGFR is lower in recipients that receive a kidney from a donor <18 kg (3-month eGFR; 36.3 vs 49.7 mL/min/1.73 m², P = .01), but quickly rebounds with no significant differences thereafter. As such, efforts should be made to revisit the practice of en bloc kidney transplantation from small pediatric donors. Given similar complication rates and outcomes seen at our center between the 2 groups, “splitting first” should be the policy to ensure maximalization of transplant recipients.