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Accelerating kidney allocation: Simultaneously expiring offers.

Michal A Mankowski1, Martin Kosztowski2,3, Subramanian Raghavan4

  • 1Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|April 24, 2019
PubMed
Summary
This summary is machine-generated.

Implementing simultaneous kidney offers to multiple transplant centers can significantly reduce kidney discard rates. This strategy improves organ utilization by speeding up acceptance and allocation for both high and low-risk kidneys.

Keywords:
Scientific Registry for Transplant Recipients (SRTR)clinical research/practicedelayed graft function (DGF)health services and outcomes researchkidney transplantation/nephrologymathematical modelorgan allocationorgan procurement and allocation

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Area of Science:

  • Transplantation immunology
  • Organ allocation policy
  • Nephrology

Background:

  • Kidney transplant discard rates remain a concern, particularly for nonideal organs.
  • Current sequential organ offer systems can lead to delays and increased discard rates.

Purpose of the Study:

  • To evaluate a revised kidney allocation strategy aimed at reducing organ discard.
  • To assess the impact of simultaneous multi-center offers on kidney acceptance and allocation times.

Main Methods:

  • Simulation using 2010 Kidney-Transplant Simulated Allocation Model-Scientific Registry for Transplant Recipients data.
  • Allocation of 12,933 non-local, non-zero-mismatch kidneys.
  • Comparison of simultaneous offers in small, medium, and large batches of transplant centers.

Main Results:

  • Increasing batch size for simultaneous offers significantly improved kidney acceptance rates.
  • For low-Kidney Donor Risk Index kidneys, acceptance increased from 92% to 98%.
  • For high-Kidney Donor Risk Index kidneys, acceptance increased from 65% to 89%.

Conclusions:

  • Simultaneous organ offers can accelerate kidney allocation and decrease discards.
  • This approach enhances the utilization of both ideal and nonideal donor kidneys.
  • The strategy balances improved organ acceptance with manageable screening burdens for centers.