A call to action: Feasible strategies to reduce the discard of transplantable kidneys in the United States

Stewart, Zoe A.; Shah, Shimul A.; Formica, Richard N.; Kandaswamy, Raja; Paramesh, Anil; Friedman, Jessica; Squires, Ronald A.; Cooper, Matthew; Axelrod, David A.

doi:10.1111/ctr.13990

Cited by 12 publications

(12 citation statements)

References 31 publications

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“…In response to these barriers, some organ procurement organizations have invoked "open" or expedited offers to "aggressive" centers with local back-up for known "hard-to-place" DD kidneys in order to promote utilization. 156,166,167,169,171,174 However, this practice remains a contingency alternative and functions outside of standard UNOS policy for kidney allocation. In addition, machine learning algorithms have been recently studied as a method to predict kidney discard.…”

Section: Unusual Aspects Of Dktmentioning

confidence: 99%

“…Unfortunately, the US appears to have amongst the highest kidney discard rates in the world 148–164 . A number of potential solutions to the “discard crisis” have been proposed, some of which involve “rescue allocation” with DKT 156,158,166–175 . At present, more than 5000 kidneys that are recovered from DDs with the intent to use them for transplantation are discarded annually in the United States although many believe that a substantial proportion of these kidneys may be “usable” for transplantation in the “right” recipient.…”

Section: Introductionmentioning

confidence: 99%

“…[148][149][150][151][152][153][154][155][156][157][158][159][160][161][162][163][164] A number of potential solutions to the "discard crisis" have been proposed, some of which involve "rescue allocation" with DKT. 156,158,[166][167][168][169][170][171][172][173][174][175] At present, more than 5000 kidneys that are recovered from DDs with the intent to use them for transplantation are discarded annually in the United States although many believe that a substantial proportion of these kidneys may be "usable" for transplantation in the "right" recipient.…”

mentioning

confidence: 99%

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Dual kidney transplants from adult marginal donors: Review and perspective

Stratta

Harriman

Gurram

et al. 2022

Clinical Transplantation

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The practice of dual kidney transplantation (DKT) from adult marginal deceased donors (MDDs) dates back to the mid-1990s with initial pioneering experiences reported by the Stanford and Maryland groups, at which time the primary indication was estimated insufficient nephron mass from older donors. Multiple subsequent studies of short and long-term success have been reported focusing on three major aspects of DKT: Identifying appropriate selection criteria and developing scoring systems based on pre-and post-donation factors; refining technical aspects; and analyzing mid-term outcomes. The number of adult DKTs performed in the United States has declined in the past decade and only about 60 are performed annually. For adult deceased donor kidneys meeting double allocation criteria, > 60% are ultimately not transplanted. Deceased donors with limited renal functional capacity represent a large proportion of potential kidneys doomed to either discard or non-recovery. However, DKT may reduce organ discard and optimize the use of kidneys from MDDs. In an attempt to promote utilization of MDD kidneys, the United Network for Organ Sharing introduced new allocation guidelines pursuant to DKT in 2019. The purpose of this review is to chronicle the history of DKT and identify opportunities to improve utilization of MDD kidneys through DKT. K E Y W O R D Sdual kidney transplants, index, kidney discard, kidney donor profile marginal deceased donors, nephron mass INTRODUCTIONFor patients with end stage renal disease (ESRD), kidney transplantation is associated with extended life expectancy, improved quality of life, and has proven to be cost-effective long-term compared to any type of dialysis. 1-6 As of August 2021, the United Network for Organ Sharing (UNOS) national waiting list for solid organ transplantation had nearly 107 000 total candidates, including > 90 000 patients (84.6%) awaiting kidney transplantation. 7 Unfortunately, only 22 817 kidney

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Section: Unusual Aspects Of Dktmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Dual kidney transplants from adult marginal donors: Review and perspective

Stratta

Harriman

Gurram

et al. 2022

Clinical Transplantation

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“…Accurate biopsy data utilizing AI solutions could facilitate more rapid placement of organs, as the community appears not yet ready to significantly limit biopsies, as some have proposed. 65,66 A pilot trial to assess the feasibility of surgeon willingness to defer access to biopsy information at the time of offer acceptance is under way. 67…”

Section: Recommendationsmentioning

confidence: 99%

A Roadmap for Innovation to Advance Transplant Access and Outcomes: A Position Statement From the National Kidney Foundation

Lentine

Pastan

Mohan

et al. 2021

American Journal of Kidney Diseases

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Over the past 65 years, kidney transplantation has evolved into the optimal treatment for patients with kidney failure, dramatically reducing suffering through improved survival and quality of life. However, access to transplant is still limited by organ supply, opportunities for transplant are inequitably distributed, and lifelong transplant survival remains elusive. To address these persistent needs, the National Kidney Foundation convened an expert panel to define an agenda for future research. The key priorities identified by the panel center on the needs to develop and evaluate strategies to expand living donation, improve waitlist management and transplant readiness, maximize use of available deceased donor organs, and extend allograft longevity. Strategies targeting the critical goal of decreasing organ discard that warrant research investment include educating patients and clinicians about potential benefits of accepting nonstandard organs, use of novel organ assessment technologies and real-time decision support, and approaches to preserve and resuscitate allografts before implantation. The development of personalized strategies to reduce the burden of lifelong immunosuppression and support "one transplant for life" was also identified as a vital priority. The panel noted the specific goal of improving transplant access and graft survival for children with kidney failure. This ambitious agenda will focus research investment to promote greater equity and efficiency in access to transplantation, and help sustain long-term benefits of the gift of life for more patients in need.As this article reflects the official position of the National Kidney Foundation (NKF) and because it was reviewed and approved by NKF, it was not peer reviewed by AJKD. This article was prepared by a work group comprising the authors and chaired by Dr Krista Lentine. It was reviewed and approved by the NKF Scientific Advisory Board and the NKF Executive Committee.Complete author and article information provided before references.

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“…Procurement frozen section biopsies are frequently performed to evaluate pathologic changes in high KDPI kidneys, despite evidence that the current system of interpretation by local on-call pathologists provides inconsistent data and increases the rate of inappropriate organ discard [ 10 ]. Given the complexity of interpretation of these biopsies and the inherent time limitations, use of AI to interpret whole-slide multilevel images shows promise in early trials [ 11 , 12 ].…”

Section: Pretransplant Evaluation Of Donors and Recipientsmentioning

confidence: 99%

Technology-Enabled Care and Artificial Intelligence in Kidney Transplantation

Schwantes

Axelrod

2021

Curr Transpl Rep

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Purpose of Review Artificial intelligence (AI), machine learning, and technology-enabled remote patient care have evolved rapidly and have now been incorporated into many aspects of medical care. Transplantation is fortunate to have large data sets upon which machine learning algorithms can be constructed. AI are now available to improve pretransplant management, donor selection, and post-operative management of transplant patients. Recent Findings Changes in patient and donor characteristics warrant new approaches to listing and organ acceptance practices. Machine learning has been employed to optimize donor selection to identify patients likely to benefit from transplantation of higher risk organs, increasing organ discard and reducing waitlist mortality. These models have greater precisions and predictive ability than currently employed metrics including the Kidney Donor Profile Index and the expected posttransplant survival models. After transplant, AI tools have been developed to optimize immunosuppression management, track patients adherence, and assess graft survival. Summary AI and technology-enabled management tools are now available throughout the transplant journey. Unfortunately, those are frequently not available at the point of decision (patient listing, organ acceptance, posttransplant clinic), limiting utilization. Incorporation of these tools into the EMR, the Donor Net® organ offer system, and mobile devices is vital to ensure widespread adoption.

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A call to action: Feasible strategies to reduce the discard of transplantable kidneys in the United States

Cited by 12 publications

References 31 publications

Dual kidney transplants from adult marginal donors: Review and perspective

Dual kidney transplants from adult marginal donors: Review and perspective

A Roadmap for Innovation to Advance Transplant Access and Outcomes: A Position Statement From the National Kidney Foundation

Technology-Enabled Care and Artificial Intelligence in Kidney Transplantation

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