Strategy for eliminating the kidney shortage.

1. We anticipate that the number of kidneys from conventional heart beating donors who are under age 55 will remain stable at about 8,000/year. A natural increase of donors over age 55 and living donors is expected to increase the total transplants from about 12,000 today to 14,000 in 8 years. 2. We propose a 4-year acceleration phase, during which older cadaver donors, related and unrelated living donors will be increased to a maximum of 4,000 in the 4th year. This acceleration is a temporary one, and will be reduced to zero over 4 subsequent years. 3. An increase in NHBD will be encouraged at a rate of 700/year, so that at the end of 14 years, they would constitute about 10,000 cadaver donor kidneys. As can be seen in Figure 1, at this rate, NHBD kidneys will first replace the accelerated effort, then replace the living donors and eventually the older heart beating donors. With the abundance of kidneys, it is likely that many patients who are not listed today would be encouraged to become transplant candidates. Moreover, patients needing retransplants will increase. However, once this capacity is developed, any increases in new transplant candidates could be accommodated. Thus in 14 years, there will be about 18,000 kidneys available each year. Approximately 60% will be NHBD and 40% heart beating donors, with no living donors and no older donors and no need of pig donors. We will be in transplant nirvana.