Purpose of reviewKidney transplantation indisputably confers a significant survival advantage and a better quality of life compared with dialysis, however, because of the increasing demand for kidney transplantation many patients continue to wait prolonged periods for kidney transplantation. The first step to alleviate the shortage is to reduce the discard rate by utilizing more marginal kidneys. This review studied the recent literature on marginal kidney transplantation. Recent findingsMore than 60% of high-KDPI kidneys are discarded. Despite the increase in posttransplant costs, use of high KDPI transplants suggests a gain in survival years, thus making marginal kidney transplant cost effective. Furthermore, recent evidence suggests that marginal kidney transplantation shows a survival benefit compared with remaining in the waitlist and minimizes the kidney discard rate.

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BACKGROUND Digital surgical simulation and telecommunication provides an attractive option for improving surgical skills, widening access to training, and improving patient outcomes; however, it is unclear whether sufficient simulations and telecommunications are accessible, effective, or feasible in low-middle income countries (LMICs). OBJECTIVE This review aims to use implementation outcomes to provide an evidence map of how simulation and telecommunications is being implemented in the training and education of surgical trainees in LMICs. METHODS We searched PubMed, MEDLINE, Embase, Web of Science, Cochrane Database of Systematic Reviews, and the Central Register of Controlled Trials up until March 2022 to look for qualitative studies in published literature discussing implementation and outcomes of surgical simulation training in LMICs. RESULTS Technologies have included mobile applications, robotic training, video game simulations, virtual reality, and computerized methods of standardized assessment. Broadly, there is strong initial user acceptability of such technologies with many users willing to adopt the simulation tools again in the future. Some devices required extensive training and problems with devices during periodic checks of technology seemed to be the largest mitigating factor in feasibility of technologies. Current literature consists of mostly small qualitative and survey-based pilot studies and lacks significant quantitative results on feasibility criteria of new simulation and telecommunication technologies. Few studies include participants as women, highlighting a need for inclusive approaches to research in the future. CONCLUSIONS Implementation strategy must look towards implementation cost, appropriateness, fidelity, and substantiality as factors to prime the most successful uptake of these effective training tools. CLINICALTRIAL N/A