Five UNOS researchers (Darren Stewart, M.S.; Victoria Garcia, M.P.H.; John Rosendale, M.S.; David Klassen, M.D.; and Bob Carrico, Ph.D.) recently analyzed factors underlying the steady increase in discards of deceased donor kidneys recovered for transplantation, most notably in the last decade. Their study is available in the “Early View” (pre-print) online feature of the journal Transplantation.
The kidney discard rate more than tripled from the late 1980s to 2009, from approximately five percent to nearly 20 percent. The study found that at least 80 percent of the increase in the discard rate can be explained by the expansion of kidney donor criteria and clinical practice changes in biopsies and pump preservation of recovered kidneys. However, these factors did not account for some residual change. The researchers conclude that behavioral factors, such as concern over use of kidneys with greater donor risk, and/or inefficiency in kidney allocation may have played some role. Efforts to reduce risk aversion and improve allocation may help improve utilization, as may more frequent pump perfusion of less-than-ideal but potentially transplantable kidneys.