Back-bench split of a deceased-donor horseshoe kidney for two transplant recipients

The great discrepancy between available donors and those waiting for renal transplantation has led to creative strategies to maximize the deceased donor pool. One such strategy is utilization of donor organs with anatomic abnormalities. Horseshoe kidney is the most common renal abnormality, with an estimated incidence of 1 in 600 to 800. Fusion in a horseshoe kidney is most commonly a thick isthmus of renal parenchyma connecting the lower poles. Vascular and collecting-system anomalies are also very common and add to the challenge of using these organs for transplantation. The donor was a 45-year-old man who died of a blunt head trauma and had a terminal serum creatinine of 0.7 mg/dl.