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Review
. 2023 Feb 28;38(3):787-796.
doi: 10.1093/ndt/gfac300.

Kidney utilization in the Netherlands - do we optimally use our donor organs?

Rianne Schutter  1 , Willemijn A L Vrijlandt  1 , Gelske M Weima  1 , Robert A Pol  1 , Jan-Stephan F Sanders  2 , Meindert J Crop  2 , Henri G D Leuvenink  1 , Cyril Moers  1
Affiliations
Review

Kidney utilization in the Netherlands - do we optimally use our donor organs?

Rianne Schutter et al. Nephrol Dial Transplant. .

Abstract

Background: To ensure optimal utilization of deceased donor kidneys, it is important to understand the precise reasons why kidneys are discarded. In this study we aimed to obtain a comprehensive overview of kidney utilization and discard during the entire donation process in the Netherlands.

Methods: In this retrospective cohort study we analysed kidney utilization of 3856 kidneys in the Netherlands between 1 January 2015 and 31 December 2020. For every kidney that was not transplanted, we determined the moment of and reason for discard through a unique case-by-case assessment.

Results: Kidney discard according to the traditional definition (procured but not transplanted) was 7.8%. However, when kidneys that seemed medically suitable at the beginning of the donation process were also included, many more potential donor kidneys were lost and the total non-utilization was 24.4%. Subjectively presumed impaired organ quality was responsible for 34.2% of all discarded kidneys. Two-thirds of kidneys discarded due to acute kidney injury (AKI) had only AKI stage 1 or 2.

Conclusion: The classical definition of organ discard underestimates the non-utilization of deceased donor kidneys. Strategies to improve kidney utilization could be a revision of the maximum allowed agonal time in donation after circulatory death, careful consideration in reporting and accepting kidneys from donors with AKI and a prospectively filled registry of detailed organ discard reasons, including the 'silent' non-utilization before procurement.

Keywords: discard; kidney utilization; organ donation.

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Figures

Graphical Abstract
Graphical Abstract
Figure 1:
Figure 1:
Average annual loss of potential donors and kidneys. a310 reported donors derived from the ICU patient population. On average, 11 patients per year chose to have euthanasia carried out in the hospital to facilitate subsequent organ donation, for a total of 321 reported organ donors per year. bThe odd number of kidneys is because donors had a medical history of a previously donated single kidney as a living donor, a unilateral nephrectomy for medical reasons or a congenital single kidney. DCD: donation after circulatory death; ET: Eurotransplant; HD: haemodynamic; WIT: warm ischaemia time.
See this image and copyright information in PMC

References

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