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Diagnosing the Recent Decrease in Utilization of Deceased Donor Kidneys.

Nicholas L Wood¹, Douglas N VanDerwerken², Allan B Massie³

¹Hennepin Healthcare Research Institute, Minneapolis, MN.

Transplantation

|February 20, 2025

Summary

This summary is machine-generated.

The kidney allocation system (KAS250) increased kidney nonuse by delaying offers and accepting more nonideal donors. Recovering more kidneys, even from nonideal donors, is crucial for increasing transplants.

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Area of Science:

Nephrology
Transplant Surgery
Public Health Policy

Background:

Deceased donor kidney transplants are at a record high.
Kidney nonuse has risen to 25.8% since the Kidney Allocation System 250 (KAS250) implementation.
KAS250 is a circular kidney allocation system based on 250-nautical-mile circles.

Purpose of the Study:

To investigate factors contributing to kidney nonuse after KAS250 implementation.
To analyze the association of nonideal donor recovery and offer acceptance delays with kidney nonuse.
To assess the impact of COVID-19 on kidney nonuse rates.

Main Methods:

Utilized Scientific Registry of Transplant Recipients data from March 2019 to January 2023.
Calculated kidney nonuse rates before and after KAS250 implementation.
Examined associations between nonuse and donor characteristics, KAS250 delays, and COVID-19.

Main Results:

Kidney nonuse increased from 21.2% to 25.8% post-KAS250.
Offer acceptance delays under KAS250 were linked to 33% of nonused kidneys.
Increased recovery of nonideal donors (43%) and an unexplained trend (23%) also contributed to nonuse. COVID-19 impact was not significant.

Conclusions:

The rise in kidney nonuse is associated with KAS250's complexity and delays.
Increased recovery of nonideal donors, while contributing to nonuse, ultimately benefits patients by increasing kidney availability.
Strategies are needed to mitigate KAS250-related delays and optimize the use of recovered kidneys.