Study: Variables Affecting Deceased-Donor Kidney Acceptance Rates

Renal transplant remains the undisputed best treatment for most patients suffering from end stage renal disease. The nephrology community continues to drive toward expanding the pool of available allografts, from both deceased and living donors. Therefore, data that sheds light on the allograft decision process may ultimately better help transplant teams navigate their expanding waiting lists.

A recent observational study published in the Clinical Journal of the American Society of Nephrology reviewed seven million deceased-donor adult kidney offers over five years to evaluate donor kidney acceptance rates across transplant centers. The study highlighted variables that affect organ acceptance and denials based upon donor-specific characteristics, waitlist-recipient patient characteristics and transplant center-specific policies that potentially contribute to the variance.

Notably, the authors found significant variation in deceased-donor kidney acceptance rates. Similarly, organs were routinely refused multiple times before ultimately being accepted for transplantation. The acceptance rate varied significantly between centers and recipient/donor clinical criteria.  Specifically, the investigators cited a median of seven offers per allograft before acceptance for transplantation. Reasons for rejecting an organ included:

• Donor-related factors, such as patient age or organ quality
• Transplant center bypass, such as the minimum acceptance criteria were not met

After adjusting for the above-listed characteristics, male and Hispanic waitlisted patients were more likely to experience a transplant offer rejection than female and white patients. On the basis of these findings, variables, including race, gender, donor characteristics and transplant center policies, may explain some of the differences in the acceptance rate for deceased-donor kidney offers. The authors of this study also note their “findings on organ acceptance may be due to clinical appropriateness, biologic factors or subconscious biases.”

While this study doesn’t necessarily offer solutions, the authors correctly state that their “results have implications for patients, providers, researchers and policy makers.”  Further evaluation of the organ allocation and acceptance process with an intent to improve efficiency and increase organ availability is warranted.