Top 5 Reasons Kidneys are Discarded

In the USA, nearly one in five donated kidneys (3,159) recovered with intent to transplant were discarded in 2015. This is happening despite nearly 100,000 patients waiting for a transplant, 22 dying every day, and over 600,000 patients with end-stage renal disease that would benefit from a transplant. Why in the hell don't more get transplanted? Here are the top 5 reasons we found:

  1. Increased recovery of bad kidneys - The kidney donor criteria and the pool has expanded immensely to include recovery of more marginal kidneys which has increased the number of both transplants and discards.
  2. Risk aversion of transplant centers - Program-specific reports measuring a center's transplant outcomes, though well risk-adjusted, still concern some centers that feel they are on disadvantaged due to unadjusted confounders.
  3. Ran out of time - The process takes too long and a recipient is not found before the kidney accumulates too many hours of cold ischemia time and the organ is discarded. The proverbial game of hot potato.
  4. No recipient located/Transplant list exhausted - All transplant candidates were considered and denied the kidney offer.
  5. Misleading diagnostic tests - Increased biopsy rates have increased discard rates despite not being reliable.

Stewart, D. E., Garcia, V. C., Rosendale, J. D., Klassen, D. K., & Carrico, B. J. (2017). Diagnosing the Decades-Long Rise in the Deceased Donor Kidney Discard Rate in the United States, 101(3). https://doi.org/10.1097/TP.0000000000001539

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