OPTN/SRTR 2020 Annual Data Report: DOD

Abstract

SRTR uses data collected by OPTN to calculate metrics such as donation rate, organ yield, and rate of organs recovered for transplant but not transplanted. In 2020, there were 12,588 deceased donors, an increase from 11,870 in 2019; this number has been increasing since 2010. The number of deceased donor transplants increased to 33,303 in 2020, from 32,313 in 2019; this number has been increasing since 2012. The increase may be due in part to the rising number of deaths of young people amid the ongoing opioid epidemic. The number of organs transplanted included 18,410 kidneys, 962 pancreata, 8350 livers, 91 intestines, 3722 hearts, and 2463 lungs. Compared with 2019, transplants of all organs except pancreata and lung transplants increased in 2020, which is remarkable despite the pandemic caused by the SARS‐CoV2 virus. In 2020, 4870 kidneys, 294 pancreata, 861 livers, 3 intestines, 39 hearts, and 115 lungs were discarded. The number of discards was similar to that of the previous year. In 2019, 4,324 kidneys, 346 pancreata, 867 livers, 5 intestines, 31 hearts, and 148 lungs were discarded. These numbers suggest an opportunity to increase numbers of transplants by reducing discards. Despite the pandemic, there was no dramatic increase in number of discards and an increase in total number of donors and transplants.

Kidney utility and futility

“…Almost half of the patients over 60 years of age are projected to die on the kidney waiting list prior to receiving a deceased donor kidney transplant 37 . Of the approximately 600,000 patients currently on dialysis in the United States, less than 10%–14% will ever be placed on the kidney waiting list and less than half will actually receive a kidney transplant 13,38,39 . Only 25% of active wait‐list candidates are transplanted in a given year, and the chance of actually receiving a deceased donor kidney transplant within 1 year of listing is less than 10% and only 15% at 2 years 13,14 .…”

“…Kidney discard rates are increasing, CITs are longer, and the number of donations after cardiocirculatory death and acute kidney injury donors are rising out of proportion to other types of deceased donors. [11][12][13] The number of kidneys recovered with the intent to transplant but ultimately discarded in the United States (US) has doubled in recent years and is approaching 8000 kidneys per annum. 14 The rate of kidney non-utilization (>20%) in the US is among the highest reported globally and is double the rate of discard reported by other organ donor systems.…”

“…37 Of the approximately 600,000 patients currently on dialysis in the United States, less than 10%-14% will ever be placed on the kidney waiting list and less than half will actually receive a kidney transplant. 13,38,39 Only 25% of active wait-list candidates are transplanted in a given year, and the chance of actually receiving a deceased donor kidney transplant within 1 year of listing is less than 10% and only 15% at 2 years. 13,14 Therefore, in spite of the promise of kidney transplantation, the overwhelming majority of patients with end-stage renal disease will not have the opportunity to receive a potentially life-prolonging and life-enhancing treatment while those fortunate enough to be placed on the waiting list are destined to wait for an excessive period and only have at best a 50:50 chance of ever receiving a kidney.…”

Normothermic Regional Perfusion Can Improve Both Utilization and Outcomes in DCD Liver, Kidney, and Pancreas Transplantation

“…The number of donation after circulatory death (DCD) donors has steadily increased during the decade, with a recent report demonstrating they account for 25% of deceased donation in the United States. 1 Because of a gap between the supply and demand in liver (LT), kidney (KT), and pancreas transplantation (PT), aggressive utilization of marginal donors is required including DCD donors. 2 However, the utilization of potential DCD donors for transplantation has remained low.…”

When the Deceased Donor Has Sustained Blunt Trauma to the Liver: What Happens Next?

“…This is not a new problem in that comprehensive reporting on the outcomes of potential deceased donors with a history of blunt trauma remains a goal rather than an actual reality. 6,7 This information gap can be addressed if more in the way of appropriate data are collected by donor registries on the potential organ donors who have sustained trauma, with further analysis and reporting then following. This will facilitate a greater understanding being gained as to what factors are contributing to the relevant decision making, including where there is practice variation.…”