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Published on: July 15, 2015
A Re-evaluation of Discarded Deceased Donor Kidneys in the UK: Are Usable Organs Still Being Discarded?
Shruti Mittal1, Anna Adamusiak, Catherine Horsfield
11 Department of Nephrology and Transplantation, Guy's Hospital, London, United Kingdom. 2 Department of Histopathology, Guy's Hospital, London, United Kingdom. 3 Department of Surgery University of Cambridge, Cambridge, United Kingdom. 4 NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, United Kingdom.
Insights
Despite the UK Kidney Fast-Track Scheme (KFTS), potentially transplantable deceased donor kidneys are still being discarded. Further analysis is crucial to reduce unnecessary organ discard and improve kidney utilization.
Area of Science:
- Nephrology
- Transplantation Surgery
- Organ Donation
Background:
- A significant number of procured deceased donor kidneys are discarded.
- The UK Kidney Fast-Track Scheme (KFTS) was implemented in 2012 to offer at-risk kidneys to multiple centers simultaneously.
- This study investigates ongoing unnecessary organ discard post-KFTS implementation.
Purpose of the Study:
- To analyze discarded kidneys after the introduction of the KFTS.
- To determine if potentially transplantable kidneys continue to be discarded unnecessarily.
Main Methods:
- 31 discarded kidneys from the UK were independently inspected by senior surgeons between April and June 2015.
- All kidneys underwent biopsy, with initial usability assessed as usable, possibly usable, or not usable.
- Final usability assessments were made after histological review.
Main Results:
- The study included 19 donors (6 brain death, 13 circulatory death) with a median age of 67 years.
- Only 3 discarded kidneys had not entered the KFTS.
- Post-histology, 10 out of 31 (32%) discarded kidneys were deemed usable for transplantation.
Conclusions:
- The KFTS effectively identifies high-risk kidneys but does not prevent all unnecessary discards.
- Potentially transplantable organs are still being discarded.
- Analysis of discarded organs is vital to identify barriers and improve organ utilization strategies.
Background:
A significant proportion of procured deceased donor kidneys are subsequently discarded. The UK Kidney Fast-Track Scheme (KFTS) was introduced in 2012, enabling kidneys at risk of discard to be simultaneously offered to participating centers. We undertook an analysis of discarded kidneys to determine if unnecessary organ discard was still occurring since the KFTS was introduced.
Methods:
Between April and June 2015, senior surgeons independently inspected 31 consecutive discarded kidneys from throughout the United Kingdom. All kidneys were biopsied. Organs were categorized as usable, possibly usable pending histology, or not usable for implantation. After histology reports were available, final assessments of usability were made.
Results:
There were 19 donors (6 donations after brain death, 13 donations after circulatory death), with a median (range) donor age of 67 (29-83) years and Kidney Donor Profile Index of 93 (19-100). Reasons for discard were variable. Only 3 discarded kidneys had not entered the KFTS. After initial assessment postdiscard, 11 kidneys were assessed as usable, with 9 kidneys thought to be possibly usable. Consideration of histological data reduced the number of kidneys thought usable to 10 (10/31; 32%).
Conclusions:
The KFTS scheme is successfully identifying organs at high risk of discard, though potentially transplantable organs are still being discarded. Analyses of discarded organs are essential to identify barriers to organ utilization and develop strategies to reduce unnecessary discard.
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