Improving Utilization of High-KDRI Organs

Significantly high discard rates of recovered expanded criteria donor kidneys in the United States have raised concerns regarding inefficient organ utilization and patient welfare – particularly for elderly patients with end-stage renal disease. Several studies have suggested more frequent transplants or dual-transplants of recovered, high-KDPI organs in such patients; however, despite the potential benefits of receiving an organ of marginal quality relative to remaining on dialysis, the absorption of high-KDPI organs by transplant centers remains largely unaffected. A proper analytic framework is required to demonstrate to the transplant community whether these discarded organs are better served when transplanted in elderly patients with low priority on the waiting list. In this proposal, we introduce a simple, patient-level decision model that assesses whether the survival gains from transplanting a marginal organ outweigh the costs and implications of remaining on dialysis. We also explain the steps to solve the model and how we intend to fulfill the data requirements using datasets obtained from Gift of Hope and the Organ Procurement Transplant Network and Scientific Registry of Transplant Recipients. The proposed final deliverable is a technical report and presentation summarizing the study and our findings.