The ‘Two, One, Zero’ Decision: What to Do with Suboptimal Deceased Donor Kidneys

Every day around the world clinicians face tough decisions: what should they do when a pair of suboptimal deceased donor kidneys are available for waiting recipients, many of whom have faced long wait times? Should they transplant two into one recipient, one each into two recipients, or discard both: the two, one, zero countdown? Often they discard them: in 2009 in the USA, 2762 (19%) of recovered deceased donor kidneys were discarded (Table 1) (http://www.ustransplant.org/annual_reports/current/302_ord.htm), and this number rises every year.