Disparities in Acceptance of Deceased Donor Kidneys Between the United States and France and Estimated Effects of Increased US Acceptance

Abstract

IMPORTANCE Approximately 3500 donated kidneys are discarded in the United States each year, drawing concern from Medicare and advocacy groups. OBJECTIVE To estimate the effects of more aggressive allograft acceptance practices on the donor pool and allograft survival for the population of US wait-listed kidney transplant candidates.

An international comparison of deceased donor kidney utilization: What can the United States and the United Kingdom learn from each other?

“…The sharply higher utilization of older and high‐KDRI kidney donors in the UK compared with the US is one of the most salient observations from this study, which echo key messages from a recent comparison of kidney utilization in the US and France . Potential explanations for these US–UK differences include the following: Kidney allocation policy differences ◦Donor–recipient age‐matching points (UK) ◦Fast track offering scheme (UK) ◦High‐KDPI consent requirement (US) Differential reliance on biopsies for ruling in and ruling out transplantable kidneys Broader (US) vs narrower (UK) geography Variations in transplant finances Differences in dialysis practices Transplant center regulatory oversight differences Cultural differences influencing patient treatment expectations …”

Transplantation of Marginal Organs: Immunological Aspects and Therapeutic Perspectives in Kidney Transplantation

“…In the multivariate Cox analysis, ECD, cold ischemia, and presence of donor-specific alloantibodies (DSA) at transplantation were significantly associated with kidney allograft loss. The model was adjusted on donor type (deceased vs. living), presence of diabetes in donor, graft rank, and number of HLA-A/B/DR mismatches (71). Recipients of ECD with circulating DSAs at the time of transplantation had the worse kidney graft outcome with a 4.4-fold increased risk of graft loss as compared to those without DSA.…”

A Patient’s Perspective on Advancing American Kidney Health Initiative

“…What are the best practices in other countries? Researchers in France theorize that, by accepting organs from older patients and patients with comorbidities, the United States could use 62% of kidneys currently discarded (6). Although France has a very different health care system, such a significant difference merits analysis.…”