RISK OF DISEASE TRANSMISSION IN AN EXPANDED DONOR POPULATION: Edited by Jeffery A. KahnExpedited placement to maximize utilization of marginal organsGiorgakis, Emmanouila; Mathur, Amit K.bAuthor Information aDivision of Transplant Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas bDivision of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA Correspondence to Amit K. Mathur, MD, MS, Associate Professor of Surgery, Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA. Tel: +1 480 342 1010; fax: +1 480 342 2324; e-mail: [email protected] Current Opinion in Organ Transplantation: December 2020 - Volume 25 - Issue 6 - p 640-646 doi: 10.1097/MOT.0000000000000827 Buy Metrics Abstract Purpose of review Deceased donation represents the largest supply of organs for transplant in the United States. Organs with suboptimal characteristics related to donor disease or recovery-related issues are increasingly discarded at the time of recovery, prompting late allocation to candidates later in the match sequence. Late allocation contributes to organ injury by prolonging cold ischemia, which may further lead to the risk of organ discard, despite the potential to provide benefit to certain transplant candidates. Recent findings Expedited placement of marginal organs has emerged as a strategy to address the growing problem of organ discard of marginal organs that have been declined late after recovery. In this review, we describe the basis for expedited organ placement, and approaches to facilitating placement of these grafts, drawing examples from kidney and liver donation and transplantation globally. Summary There is significant global variation in practice related to late allocation. Multiple policy mechanisms exist to facilitate expedited placement, including simultaneous offers to multiple centers, predesignation of aggressive centers, and increasing organ procurement organization autonomy in late allocation. Optimizing late allocation of deceased donor organs holds significant promise to increase the number of transplants. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.