Introduction:  Renal transplantation is the most successful therapy for renal failure. As of January 2023, in the US, there were 103,636 patients waiting for a kidney transplant.  Yet, only 25,000 transplants were performed in 2022 and 5,000 patients died on the waiting list.  Similarly, each year, across Europe, 10-30% of patients die waiting for a transplant. To face this severe organ shortage, the neonatal donors can be considered a source of kidneys, until now unexplored.
Material and Methods:  To assess the feasibility of neonatal organ transplantation  we analyzed the neonatal mortality in the US and other countries, the physiology of the neonatal kidneys, the medical, ethical and legal considerations associated with neonatal brain death and cardiac death, the growth of the pediatric kidneys after transplantation, and the long term function of the kidneys.  The organ procurement and the transplantation of the neonatal organs were also discussed.
Results:  Of the 21,000 infant deaths reported in 2020, taking a very conservative approach, 8,600 infants with congenital malformations (41%), 2,380 infants with CNS injury (13%) and 1,260 infants with respiratory distress (6%), or 12,240 infants could have been considered as donors.  The pediatric en bloc kidneys with full complement of nephrons:  1). have rapid catch-up growth after transplantation, 2). provide excellent long term function ( >25 years) exceeding that of living donors, 3). are not subjected to hyperfiltration, 4). can be transplanted safely using current techniques, and 5). being neonatal, they may be less immunogenic.
Conclusions:   All ethical, social, medicolegal, technical aspects have been established and are ready for use in neonatal organ donation and transplantation. Policies should be developed to facilitate early referral by the medical team (physicians, nursing staff and social services) to organ procurement personnel.  A simplified allocation system should be developed to avoid the current long cold ischemia and the high discard rate.  Efforts to implement the policies and disseminate the use of the neonatal kidneys fall in the hands of all Transplantation Societies and Organ Procurement Organizations.