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Published on: July 15, 2015
The discard of deceased donor kidneys in the UK
Chris J Callaghan1, Simon J F Harper, Kourosh Saeb-Parsy
1Department of Surgery, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
Insights
Discard rates for deceased donor kidneys in the UK have risen significantly. A review found many discarded kidneys were potentially usable, prompting system changes to improve kidney utilization.
Area of Science:
- Nephrology
- Transplantation Surgery
- Public Health Policy
Background:
- Minimizing discard of procured deceased donor kidneys is crucial.
- Limited data exists on discard rates and avoidance strategies.
- UK discard rates increased from 5% to 12% between 2002-3 and 2011-12.
Purpose of the Study:
- To assess the appropriateness of discarded deceased donor kidneys.
- To evaluate the effectiveness of the Declined Kidney Scheme.
- To identify areas for improvement in kidney utilization.
Main Methods:
- Analysis of the UK Transplant Registry data (2002-2012).
- Review of 20 discarded kidneys from 13 deceased donors.
- Surgeon assessment of kidney implantability.
Main Results:
- Discard rate increased to 12% by 2011-12.
- Only 13% of discarded kidneys were offered via the Declined Kidney Scheme.
- 20% of reviewed discarded kidneys were deemed usable, and 45% possibly usable.
Conclusions:
- Significant proportion of discarded kidneys were potentially viable.
- The UK deceased donor kidney offering system required major revisions.
- Organizational changes are needed to enhance deceased donor kidney utilization.
Abstract:
It is essential to minimize the unnecessary discard of procured deceased donor kidneys, but information on discard rates and the extent to which discard can be avoided are limited. Analysis of the UK Transplant Registry revealed that the discard rate of procured deceased donor kidneys has increased from 5% in 2002-3 to 12% in 2011-12. A national offering system for hard-to-place kidneys was introduced in the UK in 2006 (the Declined Kidney Scheme), but just 13% of kidneys that were subsequently discarded until 2012 were offered through the scheme. In order to examine the appropriateness of discard, 20 consecutive discarded kidneys from 13 deceased donors were assessed to determine if surgeons agreed with the decision that they were not implantable. Donors had a median (range) age of 67 (31-80) yr. Kidneys had been offered to a median of 3 (1-12) centers before discard. Four (20%) of the discarded kidneys were thought to be usable, and nine (45%) were possibly usable. As a result of these findings, major changes to the UK deceased donor kidney offering system have been implemented, including simultaneous offering and broader entry criteria for hard-to-place kidneys. Organizational changes are necessary to improve utilization of deceased donor kidneys.
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