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. 2022 Jun;22(6):1593-1602.
doi: 10.1111/ajt.16967. Epub 2022 Feb 21.

The role of bypass filters in deceased donor kidney allocation in the United States

Kristen L King  1   2 , S Ali Husain  1   2 , David J Cohen  1 , Jesse D Schold  3   4 , Sumit Mohan  1   2   5
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Free article

The role of bypass filters in deceased donor kidney allocation in the United States

Kristen L King et al. Am J Transplant. 2022 Jun.
Free article

Abstract

Kidney transplant centers set organ offer filters enabling all candidates at their center to be bypassed during allocation of deceased donor kidneys from the UNOS Organ Center. These filters aim to increase allocation efficiency by preemptively screening out offers unlikely to be accepted. National data were used to compare filter settings of 175 centers in 2007 and in 2019. We examined characteristics of centers whose settings became increasingly restrictive over time, and associations between filter settings and organ offer acceptance. Overall, centers became more open to receiving offers over time, from a median 62% of filters open to receiving national offers in 2007 to 73% in 2019. Intravenous drug use filter settings changed most, from 63 to 153 willing centers. Centers with more open filter settings had higher transplant volume and offer acceptance ratios across all risk categories despite preemptively screening out fewer offers compared to centers with less open settings, but similar transplant rates. There was significant geographic heterogeneity in the distribution of centers with more open filter settings. Current center bypass filters may impact patients' access to transplantation without achieving their full potential for improving allocation efficiency.

Keywords: clinical decision-making; donors and donation: deceased; health services and outcomes research; kidney transplantation/nephrology; organ acceptance; organ allocation; organ procurement and allocation.

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References

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