Rescuing Kidneys at Risk of Discard

Project: Research project

Project Details


Kidney transplant (KT) is a superior alternative to dialysis with respect to longevity, quality of life, morbidity, and cost for End-Stage Renal Disease (ESRD) patients. However, more than 97,000 patients are presently waiting to receive a KT. Greater than 18% of donated kidneys are discarded and not used for transplantation. The quality of a donated kidney is measured by the Kidney Donor Profile Index (KDPI). The KDPI score ranging from 0-100 indicates the percentage of donated kidneys that would have a lower relative-risk of graft failure. Discard rates of donated kidneys increase dramatically with increasing KDPI, with more than half of the donated kidneys with KDPI > 85% being discarded. It is also established that many of the high-KDPI kidneys would have conferred significant survival benefits to recipients relative to remaining on dialysis. Unfortunately, the allocation system does not reliably direct organs that would otherwise be wasted to such individuals. An improved Organ Procurement and Transplant Network (OPTN) is needed to lower the number of discarded organs, improve patient outcomes, and reduce regional differences in transplant rates and waiting times. However, each potential design for the OPTN must confront multiple objectives. Our research team will be rigorous and methodical in developing improved OPTN designs that acknowledge these conflicting aims. First, we will engage the kidney transplantation community (providers, patients, and OPTN professionals) and families of organ donors and elicit their preferences for how the OPTN should meet various tradeoffs in performance, fairness, and economy, all measured using metrics established by the literature or recent policy discussions in the community. The stated-preference methodology, tailored for each stakeholder group, will be used to estimate the relative importance of the different metrics. We will develop open-source simulation software of kidney allocation and the OPTN (KSIM) that will be publicly available. The simulation will incorporate transplant center-specific behaviors based on history and mechanisms that evaluate the effects of future policy changes on donation rates, patient listing rates, and discard rates for donated organs. Alternative OPTN designs will be constructed and simulated in KSIM. The overall goal to develop designs that require minimal external interventions to allocation policies over time. The methodology will incorporate the preferences elicited from the stakeholders. Leadership and policy experts from the United Network of Organ Sharing (UNOS), which directs the OPTN under a contract from the Health Resources and Services Administration (HRSA) and Organ Procurement Organizations will provide further input as members on the Scientific Advisory Board. The research outcome will be widely disseminated through multiple mechanisms. The research team is highly qualified to perform the proposed work from their past experiences on organ allocation and domain knowledge.
Effective start/end date4/1/193/31/23


  • National Institute of Diabetes and Digestive and Kidney Diseases (5R01DK118425-04)


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