Aubert O, Reese PP, Audry B, et al. - Via a nationwide study using authorized registries from the United States and France including comprehensive cohorts of deceased donors with organs given to kidney transplant centers between January 1, 2004, and December 31, 2014, researchers predicted the impacts of more aggressive allograft acceptance practices on the donor pool and allograft survival for the population of US wait-listed kidney transplant candidates. From deceased donors between 2004 and 2014, 156,089 kidneys were recovered, of which 128,102 were transplanted, and 27,987 were rejected. In France, 27,252 were transplanted, and 2,732 were rejected among the 29,984 kidneys recovered between 2004 and 2014. In France, the mean (SD) age of kidneys transplanted in the United States was 36.51 years vs 50.91 years. Kidney quality exhibited little variation in the United States over time, whereas a steadily growing kidney donor risk index in France highlighted a temporal trend of more aggressive organ use. It was discovered that 17,435 of kidneys rejected in the United States would have instead been transplanted under the French system. Over the 10-year observation period, a redesigned system with more aggressive organ acceptance practices would produce a supplementary 132,445 allograft life-years in the United States. Thus, a greater acceptance of kidneys from deceased donors who are elderly and have more comorbidities could give major survival advantages to the population of US wait-listed patients.