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Kidney Int. 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.

Author information

1
Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York, USA; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA; The Columbia University Renal Epidemiology (CURE) Group, New York, New York, USA. Electronic address: sm2206@cumc.columbia.edu.
2
Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York, USA; The Columbia University Renal Epidemiology (CURE) Group, New York, New York, USA.
3
Department of Surgery, Division of Transplantation, Emory University School of Medicine, Emory University, Atlanta, Georgia, USA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
4
Department of Medicine, Renal Division, Emory University School of Medicine, Emory University, Atlanta, Georgia, USA.
5
Department of Surgery, Division of Transplantation, Columbia University Medical Center, New York, New York, USA.
6
Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York, USA.

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

PMID:
29735310
PMCID:
PMC6015528
[Available on 2019-07-01]
DOI:
10.1016/j.kint.2018.02.016

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