Outcomes for Patients With a Deceased Donor Kidney Offer in the New Allocation System

Area of Science:

• Nephrology
• Transplantation Medicine
• Public Health Policy

Background:

• Disparities in kidney transplantation access persist for US patients with end-stage kidney disease.
• Recent kidney allocation policy changes correlate with a significant rise in declined organ offers.

Purpose of the Study:

• To analyze transplant and mortality rates for waitlisted candidates from 2015 to 2022.
• To evaluate the impact of kidney allocation policy changes on organ offer utilization.

Main Methods:

• Retrospective analysis of 249,145 adult waitlisted candidates.
• Examined transplant rates, mortality, and organ offer data from 2015 to 2022.

Main Results:

• The number of organ offers generated increased dramatically, from ~7.9 million in 2015 to ~29.3 million in 2022.
• Despite increased offers, 37.7% received deceased donor kidneys, 14.7% living donor kidneys, while 7.4% died and 12.7% were removed from the list.
• Median days to first offer decreased significantly, but deceased patients received numerous offers before death.

Conclusions:

• Current kidney allocation algorithms demonstrate significant inefficiencies.
• There is a critical need to revise waitlist prioritization strategies to optimize the use of deceased donor organs.
• Improving organ utilization is essential for maximizing the chances of successful kidney transplantation for end-stage kidney disease patients.