Allocation and Utilization Patterns of Deceased Donor Kidneys for Preemptive Transplantation in the United States

Abstract

Preemptive transplantation represents the ideal timing for providing a kidney transplant for patients, but the recent National Academies of Sciences, Engineering, and Medicine report recommended the elimination of preemptive deceased donor kidney transplantation because of concerns about equity. [1][2][3] Although there are compelling policy arguments to continue to encourage preemptive education, counseling, and preemptive listing, there are also economic and ethical questions about whether it is appropriate to allocate organs to preemptively waitlisted individuals when we have thousands of patients who are already treated with dialysis, especially given that preemptively listed patients tend to be socioeconomically and demographically advantaged. 4 By contrast, preemptive candidates represent a unique patient population who may be able to avoid the challenges of delayed graft function and oftentimes are seen as individuals who would be able to accept organs that might

Equity in Preemptive Kidney Transplantation

“…1 In this issue of JASN, King and colleagues investigate certain negative consequences to be considered when formulating such policy changes. 2 They find that in 2022, almost one in three preemptively transplanted kidneys had been refused for 100 or more recipients. Almost two thirds of the best kidneys went to prioritized recipients such as children, former kidney donors, and highly sensitized individuals.…”