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Kidney Transplant Candidates With High Frequency Deceased Donor Offers
Jesse D Schold1,2, Susana Arrigain1, S Ali Husain3
1Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Kidney International Reports
|June 22, 2026
Summary
A small group of candidates receive a disproportionate number of deceased donor kidney offers, leading to inefficiencies in organ allocation. Strategies to address offer declines and candidate status can improve kidney transplant efficiency.
Area of Science:
- Nephrology
- Transplantation
- Public Health Policy
Background:
- Organ allocation policies have increased deceased donor kidney offers.
- Despite increased offers, inefficiencies like donor kidney nonutilization and higher complication rates have emerged.
Purpose of the Study:
- To analyze the distribution of deceased donor kidney offers among candidates.
- To identify characteristics of high-frequency candidates (HFCs) and their impact on allocation efficiency.
Main Methods:
- Retrospective observational study using Scientific Registry Of Transplant Recipients (SRTR) data (Jan 2021-Dec 2024).
- Multivariable logistic and negative binomial models were employed to analyze offer distribution and candidate characteristics.
Main Results:
- Over 7.6 million kidney offers were analyzed for 205,780 candidates.
- 5% of candidates received 28% of offers, with high-frequency candidates (HFCs) characterized by older age, male sex, Black race, blood type O, and higher BMI.
- Centers with higher HFC proportions showed lower transplant rates and offer acceptance ratios (OARs).
Conclusions:
- Deceased donor kidney offers are disproportionately allocated to a minority of candidates.
- Addressing reasons for offer declines, optimizing offer filters, and managing candidate status are crucial for improving kidney allocation efficiency.
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