Development of organ-specific donor risk indices

Area of Science:

• Nephrology
• Hepatology
• Transplant Surgery

Background:

• Organ shortage necessitates using marginal deceased donors, including older individuals.
• Donor risk indices (DRIs) predict graft survival based on donor and recipient factors.

Purpose of the Study:

• Review and compare the kidney donor risk index (KDRI) and liver donor risk index (LDRI).
• Discuss their strengths, limitations, and applications in organ allocation.

Main Methods:

• Review of existing literature on KDRI and LDRI.
• Comparative analysis of the indices' performance and impact on transplant outcomes.

Main Results:

• KDRI may inform new kidney allocation algorithms.
• LDRI emphasizes donor factors, especially for hepatitis C virus-positive recipients, showing disproportionate survival decreases with higher donor risk.
• High LDRI livers increase costs and reduce survival in low Model for End-Stage Liver Disease score patients, a practice limited by LDRI use.
• Significant regional variations in US donor quality exist, as measured by LDRI.

Conclusions:

• Donor risk indices are crucial for objectively assessing donor variables and improving transplant outcomes.
• Continued refinement of DRIs is needed to optimize organ allocation policies and enhance allograft survival.
• Further research into indices like donor-recipient matching and retransplant donor risk index is warranted.