Factors leading to the discard of deceased donor kidneys in the United States

• Authors: Sumit Mohan, Columbia University; Mariana C. Chiles, Columbia University; Rachel Patzer, Emory University; Stephen Pastan, Emory University; S. Ali Husain, Columbia University; Dustin Carpenter, Columbia University; Geoffrey K. Dube, Columbia University; R. John Crew, Columbia University; Lloyd E. Ratner, Columbia University; David Cohen, Emory University
• Journal Title: Kidney International
• Volume: Volume 94, Number 1
• Publisher: Elsevier: 12 months | 2018-07-01, Pages 187-198
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.kint.2018.02.016
• Subjects: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Urology & Nephrology; allocation; biopsy; deceased donors; kidney transplantation; organ discard; EXPANDED CRITERIA DONORS; RISK INDEX; MARGINAL DONORS; TRANSPLANT OUTCOMES; CENTER PERFORMANCE; GRAFT OUTCOMES; BIOPSY; PROCUREMENT; ASSOCIATION; DONATION

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.