Kidney utilization in the Netherlands - do we optimally use our donor organs?

Area of Science:

• Nephrology
• Transplant Surgery
• Public Health

Background:

• Understanding deceased donor kidney discard is crucial for optimizing organ utilization.
• The Netherlands' kidney donation process requires a comprehensive analysis of utilization and discard rates.

Approach:

• A retrospective cohort study analyzed 3856 kidneys in the Netherlands from 2015-2020.
• Case-by-case assessments identified the timing and reasons for kidney discard.

Key Points:

• Kidney discard was 7.8% by traditional definition, but 24.4% when including initially suitable kidneys.
• Presumed impaired organ quality accounted for 34.2% of discarded kidneys.
• Two-thirds of kidneys discarded for acute kidney injury (AKI) were only stage 1 or 2.

Conclusions:

• The conventional definition of organ discard significantly underestimates deceased donor kidney non-utilization.
• Improving kidney utilization requires revising donation after circulatory death protocols and better assessment of donors with AKI.
• A detailed registry of discard reasons, including pre-procurement non-utilization, is essential.