Abstract
Background Reducing nonutilization of kidneys recovered from deceased donors is a current policy concern for kidney allocation in the United States. The likelihood of nonutilization is greater with a higher kidney donor risk index (KDRI) offer. We examine how opening offers for organs with KDRI.1.75 to the broader waitlist at varying points of time affects usage rates. Methods We simulate kidney allocation using data for January 2018 to June 2019 from Organ Procurement and Transplantation Network. For the simulation experiment, allocation policy is modified so that KDRI.1.75 organs are offered to all local candidates (same donation service area) after a set amount of cold time simultaneously. Open offers to candidates nationally are similarly examined. Results Simulation results (n550 replications) estimate that opening offers locally for KDRI.1.75 after 10 hours yields a nonutilization rate of 38% (range: 35%–42%), less than the prevailing rate of 55% of KDRI.1.75 kidneys. Opening offers after 5 hours yields 30% (range: 26%–34%), reducing the prevailing nonutilization rate by 45%. Opening offers nationally after 10 and 5 hours yields nonutilization rates of 11% (range: 8%–15%) and 6% (range: 4%–9%) for KDRI.1.75 kidneys, respectively. Conclusions Simulation findings indicate that opening offers and adjusting their timing can significantly reduce nonutilization of high-KDRI kidneys.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 233-240 |
| Number of pages | 8 |
| Journal | Clinical Journal of the American Society of Nephrology |
| Volume | 19 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 2024 |
Funding
R.N. Formica reports consultancy for Sanofi Pharmaceuticals and Veloxis Pharmaceuticals, nonbranded educational lectures for Sanofi, and advisory or leadership roles as an Associate Editor of CJASN and as Vice President of the OPTN Board of Directors. J.J. Friedewald reports consultancy for egenesis, Eurofins—Transplant Genomics, Inc., and Veloxis; research funding from CSL Behring, Eurofins—Viracor, Inc., Hansa BioPharma, NIH, Regeneron, and Veloxis; honoraria from Sanofi and UpToDate; patents or royalties from Northwestern University/Scripps Research Institute; and speakers bureau for Sanofi. V. Kilambi reports employment with RAND Corporation/Northwestern University and ownership interest in AMZN, FIGS, GM, and ZYNE. S. Mehrotra reports ownership interest in Geeta Services, Inc. The remaining author has nothing to disclose S. Mehrotra: National Institute of Diabetes and Digestive and Kidney Diseases (1R01DK118425-01A1). This study used data from the Organ Procurement and Transplantation Network (OPTN). The OPTN data system includes data on all donors, waitlisted candidates, and transplant recipients in the United States, submitted by the members of the Organ Procurement and Transplantation Network (OPTN). The Health Resources and Services Administration (HRSA), US Department of Health and Human Services, provides oversight to the activities of the OPTN contractor. The data reported here have been supplied by UNOS as the contractor for the Organ Procurement and Transplantation Network (OPTN). The interpretation and reporting of these data and the derived results is the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the OPTN or the US Government. The authors are grateful for the comments of three anonymous reviewers and Chris Zinner who reviewed the manuscript. Because Dr. Richard N. Formica is an Associate Editor of CJASN, he was not involved in the peer-review process for this manuscript. Another editor oversaw the peer-review and decision-making process for this manuscript.
ASJC Scopus subject areas
- Epidemiology
- Critical Care and Intensive Care Medicine
- Nephrology
- Transplantation