Deceased Donor Kidneys Offered Median of 7 Times Before Acceptance For Transplant Interview with:

Dr. Anne Huml MD Center for Reducing Health Disparities Case Western Reserve University MetroHealth Medical Center Cleveland, Ohio

Dr. Huml

Dr. Anne Huml MD
Center for Reducing Health Disparities
Case Western Reserve University
MetroHealth Medical Center
Cleveland, Ohio What is the background for this study? What are the main findings?

Response: Overall, about 600,000 Americans have end stage renal disease and require chronic dialysis treatment or a kidney transplant to survive. Compared to chronic dialysis, kidney transplantation results in better survival and quality of life and lower health care costs. Approximately 100,000 patients are listed for a kidney transplant. However, only 17,000 transplants occur per year with two-thirds of these coming from deceased donor organs. Annually, over 8,000 patients either die waiting for a kidney transplant or are removed from the waiting list for being too ill. Waiting times vary based on geography, but it is not unusual for patients to wait upwards of 5 years for a kidney transplant. There are sizeable race, gender, and socioeconomic disparities in access to kidney transplantation.

In this study, we evaluated the outcomes of deceased donor kidney offers and their association with donor and waitlisted patient characteristics. Differences in kidney offer outcomes to patients at the top of the waiting list may contribute to disparities in transplantation.

When a deceased donor organ becomes available, a match run list is created that ranks potential recipients in priority order based upon several characteristics, including waiting time and immunologic criteria. At the discretion of the transplant center, organ offers to patients on their waiting list can be accepted for transplant, or refused for a particular patient. The offers continue down the match run list in sequential order. For each potential recipient in whom the organ is not transplanted, a refusal code is generated and catalogued with the United Network of Organ Sharing, or UNOS. UNOS identifies 37 unique refusal codes and categorizes them into donor-related, transplant center bypassed for pre-specified criteria, recipient-related, histocompatibility-related, program-related, or other reasons for refusal.  What are the main findings?


Response: We obtained data for deceased donor kidney offers of organs that were eventually transplanted between May, 2007 and July, 2012. From these data, we extracted transplant events and refusal codes as well as donor and waitlisted patient characteristics.

We found that deceased donor kidneys were offered a median of 7 times before being accepted for transplantation. Refusal of an offer was most often due to donor-related factors (such as age or organ quality) or because the minimal acceptable criteria for a transplant center was not met. After adjusting for characteristics of waitlisted patients, organ donors, and transplant centers, male and Hispanic waitlisted patients were 7% and 4% less likely to have kidneys accepted for them for transplant than female and white patients, respectively. The likelihood of offer acceptance varied greatly across transplant centers. What should clinicians and patients take away from your report?

Response: Our results have implications for patients, transplant providers, and policymakers.   Patients should be aware of how the organ offer process works. Transplant providers can compare their practices to national trends and strategize how to change their center’s practices to optimize acceptances by monitoring refusals of offers, both among all waitlisted patients and among specific subgroups. This may have the greatest impact on shortening waiting times. Shedding light on this topic may encourage people to consider registering as organ donors. Policy makers may be able to develop performance metrics to assess the offer process and disseminate best practices to providers at centers with lower acceptance rates. What recommendations do you have for future research as a result of this study?

Response:   Further work is needed to better understand and improve the offer process to maximize the efficiency and equity of organ allocation. One way to do this is to determine what informative feedback can be given to transplant centers regarding the organ offer process with a specific focus on center-specific patterns in comparison to national patterns. And, by using examples about offers specifically made to the centers (e.g. recipient outcome when organ was transplanted by another transplant center).

No disclosures Thank you for your contribution to the community.


Anne M. Huml, Jeffrey M. Albert, Daryl Thornton, and Ashwini R. Sehgal

Outcomes of Deceased Donor Kidney Offers to Patients at the Top of the Waiting List CJASN CJN.10130916; published ahead of print July 27, 2017, doi:10.2215/CJN.10130916

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions. 

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