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. 2018 Jul;94(1):187-198.
doi: 10.1016/j.kint.2018.02.016. Epub 2018 May 5.

Factors leading to the discard of deceased donor kidneys in the United States

Sumit Mohan  1 , Mariana C Chiles  2 , Rachel E Patzer  3 , Stephen O Pastan  4 , S Ali Husain  2 , Dustin J Carpenter  5 , Geoffrey K Dube  6 , R John Crew  6 , Lloyd E Ratner  5 , David J Cohen  6
Affiliations

Factors leading to the discard of deceased donor kidneys in the United States

Sumit Mohan et al. Kidney Int. 2018 Jul.

Abstract

The proportion of deceased donor kidneys procured for transplant but subsequently discarded has been growing steadily in the United States, but factors contributing to the rising discard rate remain unclear. To assess the reasons for and probability of organ discard we assembled a cohort of 212,305 deceased donor kidneys recovered for transplant from 2000-2015 in the SRTR registry that included 36,700 kidneys that were discarded. 'Biopsy Findings' (38.2%) was the most commonly reported reason for discard. The median Kidney Donor Risk Index of discarded kidneys was significantly higher than transplanted organs (1.78 vs 1.12), but a large overlap in the quality of discarded and transplanted kidneys was observed. Kidneys of donors who were older, female, Black, obese, diabetic, hypertensive or HCV-positive experienced a significantly increased odds of discard. Kidneys from donors with multiple unfavorable characteristics were more likely to be discarded, whereas unilaterally discarded kidneys had the most desirable donor characteristics and the recipients of their partner kidneys experienced a one-year death-censored graft survival rate over 90%. There was considerable geographic variation in the odds of discard across the United States, which further supports the notion that factors beyond organ quality contributed to kidney discard. Thus, while the discard of a small fraction of organs procured from donors may be inevitable, the discard of potentially transplantable kidneys needs to be avoided. This will require a better understanding of the factors contributing to organ discard in order to remove the disincentives to utilize less-than-ideal organs for transplantation.

Keywords: allocation; biopsy; deceased donors; kidney transplantation; organ discard.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow chart of the study population, 212,305 deceased donor kidneys recovered for transplant between 2000 and 2015
Figure 2
Figure 2
Donors with multiple unfavorable characteristics were identified using fourteen unfavorable characteristics including clinical parameters and demographics.
Figure 3
Figure 3
The frequency, type (single, unilateral, bilateral) and proportion of U.S. deceased donor kidney discards stratified by year of procurement (n = 36,700), 2000-2015
Figure 4
Figure 4
U.S. Organ quality (KDPI) of deceased donor kidney discards stratified by discard type (n =36,700), 2000-2015
Figure 5
Figure 5
Kidney Donor Risk Index (KDRI) overlap of transplanted and discarded kidneys recovered from 2000 to 2015
Figure 6
Figure 6
The adjusted odds ratio (aOR) of discard by UNOS region, 2000-2015
See this image and copyright information in PMC

References

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