A Donor Utilization Index to Assess the Utilization and Discard of Deceased Donor Kidneys Perceived as High Risk

Abstract

Background and objectives: An increasing number of patients on the waitlist for a kidney transplant indicates a need to effectively utilize as many deceased donor kidneys as possible while ensuring acceptable outcomes. Assessing regional and center-level organ utilization with regards to discard can reveal regional variation in suboptimal deceased donor kidney acceptance patterns stemming from perceptions of risk.

Design, setting, participants, & measurements: We created a weighted donor utilization index from a logistic regression model using high-risk donor characteristics and discard rates from 113,640 deceased donor kidneys procured for transplant from 2010 to 2016, and used it to examine deceased donor kidney utilization in 182 adult transplant centers with >15 annual deceased donor kidney transplants. Linear regression and correlation were used to analyze differences in donor utilization indexes.

Results: The donor utilization index was found to significantly vary by Organ Procurement and Transplantation Network region (P<0.001), revealing geographic trends in kidney utilization. When investigating reasons for this disparity, there was no significant correlation between center volume and donor utilization index, but the percentage of deceased donor kidneys imported from other regions was significantly associated with donor utilization for all centers (rho=0.39; P<0.001). This correlation was found to be particularly strong for region 4 (rho=0.83; P=0.001) and region 9 (rho=0.82; P=0.001). Additionally, 25th percentile time to transplant was weakly associated with the donor utilization index (R²=0.15; P=0.03).

Conclusions: There is marked center-level variation in the use of deceased donor kidneys with less desirable characteristics both within and between regions. Broader utilization was significantly associated with shorter time to transplantation.

Keywords: adult; humans; kidney; kidney transplantation; linear models; logistic models; tissue and organ procurement; tissue donors; transplantation; waiting lists.

Graphical abstract

Figure 1.

Distribution of high-risk donor variables for transplanted deceased donor kidneys across transplant centers (n=182) in the United States, 2010–2016. BMI, body mass index; KDPI, kidney donor profile index; IV, intravenous; PHS-IR, Public Health Service Increased Risk.

Figure 2.

Center level donor utilization index by mean center deceased donor annual kidney transplant volume stratified by OPTN region. n=182, overall: rho=0.12; P=0.16. UNOS, United Network for Organ Sharing.