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Accumulated Refusal Count: A Signal of Kidney Nonuse Risk (Brief Communication).

Allan B Massie, Leila Yan, Ruiqi Xue

    Medrxiv : the Preprint Server for Health Sciences
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    Unused deceased-donor kidneys can be identified by accumulated refusals. A high refusal count signals nonuse risk, informing strategies to improve kidney utilization and reduce waste in organ transplantation.

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    Area of Science:

    • Nephrology
    • Transplant Surgery
    • Public Health

    Background:

    • A significant number of recovered deceased-donor kidneys are not transplanted.
    • Accumulated refusals during organ offer process indicate potential nonuse.
    • Quantifying refusal patterns can guide strategies for organ utilization.

    Purpose of the Study:

    • To estimate the probability of nonuse for deceased-donor kidneys based on accumulated refusal count (ARC).
    • To inform potential rescue strategies or out-of-sequence (OOS) placement for underutilized donor kidneys.

    Main Methods:

    • Utilized data from the Organ Procurement and Transplantation Network (OPTN) for adult deceased-donor kidneys offered in 2024.
    • Empirically estimated nonuse probability as a function of accumulated refusal count (ARC).
    • Excluded kidneys transplanted out-of-sequence (OOS) from the analysis.

    Main Results:

    • Nonuse risk exceeded 50% after 6 refusals for blood type O, 4 for A/B, and 1 for AB kidneys.
    • Risk surpassed 80% after 128 (O), 55 (A), 50 (B), and 14 (AB) refusals.
    • C-statistics for ARC by blood type ranged from 0.896 to 0.933, indicating strong predictive power.

    Conclusions:

    • Accumulated refusal count (ARC) thresholds provide a practical trigger for kidney rescue allocation.
    • Implementing OOS offers or rescue strategies at specific ARC thresholds can enhance utilization of difficult-to-place kidneys.
    • This approach may improve overall deceased-donor kidney utilization by addressing center-perceived quality not captured by standard metrics.