TY - JOUR
T1 - Kidney nonprocurement in solid organ donors in the United States
AU - Yu, Kathleen
AU - King, Kristen
AU - Husain, Syed A.
AU - Dube, Geoffrey K.
AU - Stevens, Jacob S.
AU - Ratner, Lloyd E.
AU - Cooper, Matthew
AU - Parikh, Chirag R.
AU - Mohan, Sumit
N1 - Funding Information:
This work was supported in part by Health Resources and Services Administration contract 234‐2005‐370011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the US Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. KY acknowledges funding from the New York Academy of Medicine (Margaret E. Mahoney Fellowship). SAH is supported by the National Center for Advancing Translational Sciences (KL2 TR001874). CRP is supported by the National Institutes of Health/National Institutes of Diabetes and Digestive and Kidney Diseases (R01 DK93770). SM is supported by National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK114893, U01 DK116066) and the National Institute of Minority Health and Health Disparities (R01 MD014161).
Funding Information:
This work was supported in part by Health Resources and Services Administration contract 234-2005-370011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the US Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. KY acknowledges funding from the New York Academy of Medicine (Margaret E. Mahoney Fellowship). SAH is supported by the National Center for Advancing Translational Sciences (KL2 TR001874). CRP is supported by the National Institutes of Health/National Institutes of Diabetes and Digestive and Kidney Diseases (R01 DK93770). SM is supported by National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK114893, U01 DK116066) and the National Institute of Minority Health and Health Disparities (R01 MD014161).
Publisher Copyright:
© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2020/12
Y1 - 2020/12
N2 - 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.
AB - 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.
KW - United Network for Organ Sharing (UNOS)
KW - clinical research/practice
KW - donors and donation: deceased
KW - health services and outcomes research
KW - kidney transplantation/nephrology
KW - organ acceptance
KW - organ procurement
KW - organ procurement and allocation
KW - organ procurement organization
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U2 - 10.1111/ajt.15952
DO - 10.1111/ajt.15952
M3 - Article
C2 - 32342627
AN - SCOPUS:85084804043
VL - 20
SP - 3413
EP - 3425
JO - American Journal of Transplantation
JF - American Journal of Transplantation
SN - 1600-6135
IS - 12
ER -