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. 2020 Dec;20(12):3413-3425.
doi: 10.1111/ajt.15952. Epub 2020 May 16.

Kidney nonprocurement in solid organ donors in the United States

Kathleen Yu  1   2 , Kristen King  1   2 , Syed A Husain  1   2 , Geoffrey K Dube  1 , Jacob S Stevens  1 , Lloyd E Ratner  3 , Matthew Cooper  4 , Chirag R Parikh  5 , Sumit Mohan  1   2   6
Affiliations

Kidney nonprocurement in solid organ donors in the United States

Kathleen Yu et al. Am J Transplant. 2020 Dec.

Abstract

There are limited data on the nonprocurement of kidneys from solid organ donors. Analysis of Standard Transplant Analysis and Research files was undertaken on all deceased donors in the United States with at least 1 solid organ recovered. From 2000 to 2018, 21 731 deceased donor kidneys (averaging 1144 kidneys per year) were not procured. No kidneys were procured from 8% of liver donors, 3% of heart donors, and 3% of lung donors. Compared to donors with all kidneys procured, those with none procured were older and more likely obese, black, hypertensive, diabetic, hepatitis C positive, smokers, Public Health Service - Increased Risk designated, deceased after cardiac death, or deceased after cerebrovascular accident. Although these donors had lower quality kidneys (median Kidney Donor Risk Index (interquartile range) 1.9 (1.0) vs 1.2 (0.7)), there was substantial overlap in quality between nonprocured and procured kidneys. Nearly one third of nonprocurements were attributed to donor history. Donors with elevated terminal creatinine likely resulting from acute kidney injury (AKI) had higher odds of kidney nonprocurement. Nonprocurement odds varied widely across Organ Procurement and Transplantation Network regions, with a positive correlation between donor kidney nonprocurements and kidney discards at the donation service area level. These findings suggest current discard rates underestimate the underutilization of deceased donor kidneys and more research is needed to optimize safe procurement and utilization of kidneys from donors with AKI.

Keywords: United Network for Organ Sharing (UNOS); clinical research/practice; donors and donation: deceased; health services and outcomes research; kidney transplantation/nephrology; organ acceptance; organ procurement; organ procurement and allocation; organ procurement organization.

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Conflict of interest statement

DISCLOSURE

The authors of this manuscript have conflicts of interests to disclose as described by the American Journal of Transplantation. Dr Stevens reports personal fees from Kidney International Reports. Dr Parikh is a member of the advisory board of RenalytixAI and owns equity in the same. He is also consultant for Genfit and Akebia therapeutics. Dr Mohan reports scientific advisory board membership with Angion Pharmaceuticals, personal fees from Kidney International Reports, CMS and HSAG outside the submitted work.

Figures

FIGURE 1
FIGURE 1
(A) Kidney Donor Risk Index (KDRI) and (B) terminal creatinine overlap of procured and nonprocured kidneys in donors with all available kidneys (n = 134 343) procured or no kidneys procured (n = 10 188). Median (interquartile index [IQR] boundaries) for each donor type is indicated
FIGURE 2
FIGURE 2
Procurement of nonrenal organs (heart, liver, and/or lung) based on kidney recovery status between 2000 and 2018. Includes single and bilateral procurement of lung(s)
FIGURE 3
FIGURE 3
Adjusted odds of kidney nonprocurement, stratified by donation year and terminal creatinine level (reference donor creatinine <1.00 mg/dL)
FIGURE 4
FIGURE 4
Proportion of donors with no kidneys recovered vs proportion of kidneys discarded across organ procurement organizations (OPOs) operating from 2000 to 2018, stratified by percentage of donor population with Kidney Donor Profile Index (KDPI) > 85%. There was a significant positive correlation between kidney discard and kidney nonprocurement rates across OPOs (r = .35, P = .007). Correlation for “low-risk” OPOs was r = .57 (P = .008), for “medium-risk” OPOs r = −.05 (P = .81), and for “high-risk” OPOs r = −.31 (P = .26). The percentage of donors with no kidneys procured was 6.55% (mean), 6.35% (median). The percentage of kidneys discarded was 17.26% (mean), 16.89% (median)
FIGURE 5
FIGURE 5
Adjusted odds ratio (aOR) of kidney nonprocurement by Organ Procurement and Transplantation Network (OPTN) region, 2000-2018. Region 6 was used as the reference region. The model was adjusted for body mass index (BMI), Black/African American race, hypertension, diabetes, terminal serum creatinine level, hepatitis C virus (HCV)+ status, and proteinuria
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