Are kidneys from diabetic donors safe for transplantation?

Kidney transplantation remains the preferred treatment for patients with end-stage kidney disease, offering improved survival and quality of life compared with dialysis. However, the ongoing shortage of donor organs continues to present a major global challenge.

As demand increases, transplant programmes are re-evaluating traditional donor selection criteria to safely expand the available donor pool — including the use of kidneys from donors with diabetes mellitus (DM), which were historically used with caution.

Historically, kidneys from diabetic donors were often avoided due to concerns about long-term microvascular damage and potential impact on graft function. However, with the rising prevalence of diabetes worldwide, the proportion of potential donors with DM has increased, making this an important area of reassessment in modern transplant practice.

Recent UK-based research has contributed valuable real-world data exploring outcomes in recipients of kidneys from diabetic donors.

A large retrospective study of nearly 1,000 deceased donor kidney transplants over a 10-year period in the UK examined outcomes according to donor and recipient diabetes status.

Key findings included:

• Kidneys from diabetic donors were more likely to come from older donors with additional comorbidities
• Recipients of diabetic donor kidneys were often older and more clinically complex
• The poorest outcomes were observed in diabetic recipients receiving kidneys from diabetic donors
• Importantly, donor diabetes alone did not independently predict worse patient or graft survival
• Recipient factors, particularly age and diabetes status, were stronger predictors of outcomes

Overall, when accounting for recipient characteristics, outcomes in recipients of kidneys from diabetic donors were comparable to those receiving non-diabetic donor kidneys.

Clinical interpretation

“These findings are clinically important because they challenge long-held assumptions about the automatic exclusion of diabetic donors,” explains Dr Rhys Evans.

“What the data suggest is that donor diabetes alone should not necessarily be a barrier to transplantation. Instead, outcomes are more strongly influenced by recipient factors, particularly the presence of diabetes and overall clinical condition.”

This evolving evidence supports a more individualised approach to organ allocation, focusing on balanced donor–recipient matching rather than excluding donors based on diabetes status alone.

Key considerations include:

• Recipient diabetes status
• Overall frailty and comorbidity burden
• Cardiovascular risk profile
• Careful assessment of donor kidney quality

In appropriately selected patients, kidneys from diabetic donors may safely expand the transplant pool without compromising outcomes.

Moving towards more personalised transplantation

As transplant medicine advances, there is growing recognition that maximising organ utilisation requires nuanced decision-making rather than rigid exclusion criteria.

Emerging evidence supports a shift towards personalised donor–recipient matching, aiming to improve access to transplantation while maintaining excellent clinical outcomes.

Kidneys from diabetic donors may represent a valuable and underutilised resource in kidney transplantation. With careful selection and modern clinical management, outcomes can be comparable to standard donor transplants.

A more individualised approach to allocation may help reduce waiting times and improve access to life-saving transplantation for patients with kidney failure.

Find out more information about our kidney transplant services and read the full paper Outcomes After Kidney Transplantation From Deceased Donors With Diabetes on PubMed here.