In several deceased donor kidney allocation systems, organs from elderly donors are allocated primarily to elderly recipients. The Eurotransplant Senior Program (ESP) was implemented in 1999, and since then, especially in Europe, the use of organs from elderly donors has steadily increased. The proportion of ≥60-year-old donors reported to the Collaborative Transplant Study (CTS) by European centers has doubled, from 21% in 2000-2001 to 42% in 2016-2017. Therefore, in the era of organ shortage it is a matter of debate whether kidney organs from elderly donors should only be allocated to elderly recipients or whether <65-year-old recipients can also benefit from these generally as "marginal" categorized organs. To discuss this issue, a European Consensus Meeting was organized by the CTS on April 12, 2018, in Heidelberg, in which 36 experts participated. Based on available evidence, it was unanimously concluded that kidney organs from 65- to 74-year-old donors can also be allocated to 55- to 64-year-old recipients, especially if these organs are from donors with no history of hypertension, no increased creatinine, no cerebrovascular death, and no other reasons for defining a marginal donor, such as diabetes or cancer.

Department for General and Visceral Surgery Faculty of Medicine Medical Center University of Freiburg University of Freiburg Freiburg Germany

Department of Cardiothoracic and Vascular Surgery University Hospital of Johannes Gutenberg University Mainz Germany

Department of General and Transplant Surgery University Hospital Heidelberg Heidelberg Germany

Department of Internal Medicine 4 Gastroenterology and Hepatology University Hospital Heidelberg Heidelberg Germany

Department of Internal Medicine University of Giessen Giessen Germany

Department of Nephrology and Autoimmune Diseases Transplantation Center Klinikum Stuttgart Stuttgart Germany

Department of Nephrology and Renal Transplantation ICNU Hospital Clinic Barcelona Spain

Department of Nephrology and Transplantation Cologne Merheim Medical Center Cologne Germany

Department of Nephrology Dialysis and Kidney Transplantation Faculty of Medicine Clinical Hospital Center Rijeka University of Rijeka Rijeka Croatia

Department of Nephrology Institute for Clinical and Experimental Medicine Prague Czech Republic

Department of Nephrology Klinikum rechts der Isar Technical University of Munich Munich Germany

Department of Nephrology Medinizische Klinik 3 UKF Goethe University Frankfurt Germany

Department of Nephrology Radboud Institute for Health Sciences Radboud University Medical Center Nijmegen The Netherlands

Department of Pediatric Kidney Liver and Metabolic Diseases Hannover Medical School Hannover Germany

Department of Pediatrics 1 University Children's Hospital Heidelberg Heidelberg Germany

Department of Surgery and Transplantation Swiss HPB and Transplantation Center University Hospital Zurich Zurich Switzerland

Department of Surgery General Visceral and Transplant Surgery Medical University of Graz Graz Austria

Department of Surgery University Hospital Knappschaftskrankenhaus Bochum Ruhr University Bochum Bochum Germany

Department of Surgical Research Clinic for General Visceral and Transplantation Surgery University Hospital Essen University Duisburg Essen Germany

Department of Visceral Transplant and Thoracic Surgery Medical University of Innsbruck Innsbruck Austria

Division of Nephrology and Dialysis Department of Medicine 3 Medical University of Vienna Vienna Austria

Division of Nephrology and Infectious Diseases Medical Clinic Gemeinschaftsklinikum Mittelrhein Koblenz Germany

Division of Nephrology Heidelberg University Hospital Heidelberg Germany

Division of Nephrology University Hospital Zurich Zurich Switzerland

Division of Thoracic Transplantation and Cardiovascular Surgery Hannover Medical School Hannover Germany

Institute of Immunology Heidelberg University Hospital Heidelberg Germany

Service de Néphrologie Dialyse Aphérèses et Transplantation CHU Grenoble Alpes Grenoble France

Service de Transplantation Rénale et Unité de Soins Intensifs AP HP Hôpital Necker Enfants Malades Paris Descartes University Paris France

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