OPTN/SRTR 2021 Annual Data Report: Deceased Organ Donation

Single center experience and literature review of kidney transplantation from non‐ideal donors with acute kidney injury: Risk and reward

“…Changes in the Kidney Allocation System, including application of the KDPI and use of concentric circles for allocation based on the donor hospital location have further contributed to equity in allocation. However, these efforts have also amplified the kidney non‐utilization rate from 10% in 1998 to 25% in 2022, which is double the rate compared to other international allocation systems with comparable donors 6–12,25–28,53–58,60–62 . At present, >7500 kidneys that are recovered from deceased donors with the intent to transplant are not used annually in the United States 62 .…”

“…States is the relentless imbalance between organ supply and demand in the setting of an increasing number of nonutilized kidneys. [6][7][8][9][10][11][12][25][26][27][28][52][53][54][55][56][57][58] As of April 2023, the UNOS national waiting list for kidney transplantation had nearly 89,000 patients. 6 Only 25% of active wait-list candidates receive kidney transplants in a given year, less than 10% within 1 year of listing and only 15% at 2 b In patients with at least 5 years follow-up.…”

“…In recent years, the number of DCD donors in the United States quadrupled from 1093 in 2012 to 4721 in 2022. 6,7 Although ECD and DCD donor kidneys increase the organ pool, their rates of nonuse and delayed graft function (DGF) remain high and long-term survival outcomes are inferior to kidneys from donation after brain death (DBD) SCDs. [7][8][9][10][11][12] For these reasons, many consider ECD and DCD donors, particularly those with acute kidney injury (AKI), to be non-ideal deceased donors (NIDD).…”

“…Although utilization of ECD kidneys may shorten waiting times and improve transplant rates, ECD kidneys are still associated with a 70% higher risk of premature graft failure and a shorter graft half‐life compared to standard criteria donor (SCD) kidneys. In recent years, the number of DCD donors in the United States quadrupled from 1093 in 2012 to 4721 in 2022 6,7 . Although ECD and DCD donor kidneys increase the organ pool, their rates of nonuse and delayed graft function (DGF) remain high and long‐term survival outcomes are inferior to kidneys from donation after brain death (DBD) SCDs 7–12 .…”

“…6,7 Although ECD and DCD donor kidneys increase the organ pool, their rates of nonuse and delayed graft function (DGF) remain high and long-term survival outcomes are inferior to kidneys from donation after brain death (DBD) SCDs. [7][8][9][10][11][12] For these reasons, many consider ECD and DCD donors, particularly those with acute kidney injury (AKI), to be non-ideal deceased donors (NIDD). 13 In December 2014, the Kidney Donor Profile Index (KDPI) scoring system, a derivative of the Kidney Donor Risk Index, was implemented into the new Kidney Allocation System, supplanting the SCD/DCD/ECD tripartite classification of deceased donor kidneys.…”