In summary, a quantitative approach to assessing quality of donor organs, such as a donor scoring system, is not perfect as pointed out by Sing et al. However, in all of our studies involving deceased donors we have found that consideration of multiple donor variables is more predictive of long-term graft survival than any single donor variable. The donor score is a practical tool as it provides a continuum of points to estimate likelihood of success following transplantation. In the case of a deceased donor kidney with improved donor score less than 20 points, there is over 75% likelihood of good or excellent renal function at one year post-transplant. In contrast, if the donor score is 20-29 points, the likelihood of good-to-excellent function falls to 45%, and with a donor score of 30 or greater the likelihood of good-to-excellent function falls to 27%. We do not feel that a scoring system should be used to categorically exclude kidneys from transplantation. But rather, a scoring system should be used as a tool to assist transplant specialists and their patients with regard to the likelihood of success following deceased donor renal transplantation. It is unlikely that a perfect tool will ever exist for predicting outcome after deceased donor renal transplantation, but we feel that it is helpful to know 'what's the score?' at the time of procurement.
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