Introduction: Despite the increase of human organs transplantation during the last decades there is a chronic inability to satisfy the transplant needs and the main obstacle to further development is the shortage of organs. Additionally the epidemiological changes of donors profile make progressively more difficult the assessment of donor suitability.
The non-standard risk donor (NSRD) project is one of the strategies adopted in Spain to adapt to this changing scenario, with the aim of ensuring the safety of solid organ transplantation. NSRDs are those donors with some condition that increases the donor related risks of transplantation in the recipient. This condition (infection, neoplasia, intoxication or others) is identified and known during the evaluation process of the donor, previously to the organ transplantation and assumed by the transplantation team.
Objectives: To know the characteristics, efficacy and utilization of organs from NSRD and to study the results of transplants performed with organs from these donors.
Methods: Data source: National Registry for organ donation and transplantation and information tool created ad hoc for the NSRD project to collect the recipients follow up. Inclusion criteria and study period: All actual NSRDs between 2013 and June 2017 and all the recipients with organ transplants from these donors. Statistics: Descriptive and survival analysis using SPSS v15.0. Follow up period varies depending on the risk condition, with a range between 3 months for infection and intoxication and 24 months for neoplasia and other.
Results:There were 8312 actual deceased organ donors during the period 2013 - June 2017; 575 (6.9%) of whom classified as NSRD: 246 (42.8%) neoplasia followed by infections (22.1%), other (21.0%) and intoxication (14.1%). 1306 transplants (7% of total number of transplants from deceased donors) were performed from NSRD:  713 kidney, 340 liver, 106 heart, 98 lung, 26 pancreas-kidney, 13 liver-kidney, 5 pancreas alone, 2 multivisceral,  1 heart-lung, 1 heart-kidney and 1 small bowel.
No death or graft loss related to donor condition has been reported. There was only one case of transmission: the heart recipient who received the graft from a known HCV donor after doing an exhaustive benefit risk evaluation. HCV infection was transmitted but sustained viral response was achieved after treatment, 3 years after transplant recipient is alive with functioning graft. No other complication related to NSRDs was reported.
Patient and graft survival is similar to the results offered by other national and international registries.
Conclusions: The use of NSRDs provides good results in terms of quality and safety and is helpful against organ shortage. NSRD project is a useful tool to ensure the prospective and systematic assessment of recipients transplanted from these donors during their follow up and provides valuable information for future risk evaluation of organ donors.