RALEIGH, N.C. - Deaths of patients awaiting kidney transplants fell nationally last year amid rising organ donation and broader use of kidneys that would once have been discarded.

Patients who would otherwise face long waits for a kidney are now often encouraged to consider organs from deceased donors older than age 60, or from younger patients who died of stroke or suffered from high blood pressure. Many transplant centers will even give a patient two low-functioning kidneys instead of one higher-functioning organ.

"In a perfect world, it would be nice to get everyone a kidney from a younger donor," says Robert Stratta, director of transplants at Wake Forest Baptist University Medical Center in Winston-Salem. "But we don't live in a perfect world. Getting a kidney is better than not getting a kidney."

So-called expanded-criteria donor organs are more likely to fail than kidneys from younger, healthier donors. Traditionally, such organs were considered unsuitable for transplant. But as the gap continues to widen between the number of patients seeking transplants and the number of organs available to them, Stratta and other experts increasingly see them as an untapped resource.

The use of expanded-criteria donor kidneys has increased about 30 percent since 2002, when the United Network for Organ Sharing set guidelines for their use. These now account for nearly 11 percent of all kidney transplants.

The number of patients seeking kidney transplants is also rising - by an average of 7 to 10 percent a year, in part because of increasing rates of type 2 diabetes, which damages the kidneys. Meanwhile, the supply of kidneys available for transplant has only inched up. Nationwide, about one quarter of patients waiting for kidney transplants got them last year.

"Hardly a week goes by that I'm not notified that someone on our waiting list has died," Stratta says.

To cut the losses, Wake Forest is aggressively using expanded-criteria donor kidneys.

But there is a trade-off: Agreeing to an "extended-criteria" kidney, Stratta says, typically shaves a year off a patient's wait. Higher-risk kidneys do tend to wear out sooner, however, lasting no more than eight years on average. (A standard transplanted kidney typically lasts about 12 years.)

A 2005 study sponsored by the Scientific Registry of Transplant Recipients found that patients who took less-than-optimal organs were less likely to die than patients who continued on dialysis and waited. Older recipients were particularly likely to benefit.

But it's not a good option for all patients. Younger people are still best served by holding out for a healthy organ from a younger donor. So closing the gap between demand and supply also depends on getting more kidneys from healthy donors.

To that end, some busy transplant programs have joined forces in recent years with organ procurement agencies as well as the federal government. When the national effort, called the Organ Donation Breakthrough Collaborative, began in 2002, only about 40 percent of families eligible to donate a loved one's organs did so. Today the average consent rate is around 60 percent nationally, with many hospitals up to 75 percent or better.

"We're recovering organs that we wouldn't have recovered five years ago," says Janet E. Tuttle-Newhall, a transplant surgeon at Duke University Medical Center and co-leader of the national collaborative.

The project emphasizes practices proven to achieve high levels of organ donation. For example, families with a hospitalized loved one near death are now routinely assigned a contact from an organ procurement organization. He or she helps the family through the grieving process to ensure the approach is made with sensitivity.

The supply of kidneys available for transplant has increased nearly 15 percent since the U.S. Department of Health and Human Services established the collaborative. And experts see signs that increasing the supply of organs is helping save lives.

Many states have passed laws that allow hospitals to treat the organ donation symbol on a driver's license as legal consent to donate.

Penny Poston of Raleigh considers herself one of the beneficiaries of efforts to increase the supply of donor kidneys. When Poston, 34, was added to Duke's waiting list more than a year ago, hoping to receive what would be her third transplant, she was told to expect a delay of up to seven years. (Patients who have had previous transplants develop antibodies that make them particularly hard to match to donor kidneys.) To Poston's relief, she received a kidney transplant Feb. 19.

"When they called to say they might have a match, I was just shocked," she said.

Poston had her first transplant at age 6 after a strep throat turned into a systemic infection that caused permanent kidney damage.

A second transplant, in 1998, turned out to be a bad match; that kidney was removed in 2002. Poston had been on dialysis since then, going to a center three days a week to have up to eight pounds of fluid drained off.

She moved to Raleigh in 2007 to live with her mother, and sought care at Duke shortly after.

With more kidneys, Poston says, "there was a better chance for me to match."