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Abstract: PO2104

Increasing Frequency of Kidneys Allocated Out of Sequence by Organ Procurement Organizations

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • King, Kristen L., Columbia University Irving Medical Center, New York, New York, United States
  • Husain, Syed Ali, Columbia University Irving Medical Center, New York, New York, United States
  • Mohan, Sumit, Columbia University Irving Medical Center, New York, New York, United States
Background

Allocation of deceased donor kidneys follows a ranked match-run list of potential recipients. Organ procurement organizations (OPOs) deviate from the mandated match-run in exceptional circumstances with unknown frequency.

Methods

Using SRTR data on all deceased donor kidney transplants (Ktx) in the US from 2015-2019, we identified cases where an OPO-initiated allocation exception occurred (Operational-OPO, Donor Medical Urgency, Expedited Placement). We examined the frequency of Ktx from these exceptions over time and characteristics of donors with kidneys placed out-of-sequence.

Results

From 2015-2019, 981 kidneys from 673 donors were transplanted via OPO-initiated allocation exception. These transplants (median KDPI 67, age 47 yrs) nearly doubled from 2015-2019: 153 kidneys in 2015 (1.5% of all Ktx) to 291 in 2019 (2.1%). 52 of 58 OPOs used this process at least once (median <1 per year), but 2 outlier OPOs accounted for 54% of the exceptions over 5 years [426 (43%) and 110 (11%), Figure 1]. Only 56% of transplant centers received any allocation-exception Ktx, with 2 centers receiving 26% [129 (13%) and 132 (13%)]. Donor kidneys placed via allocation exception had less favorable characteristics, but only 25% had KDPI≥85% (Table 1). Allocation exception Ktx went to recipients with 2 fewer priority points (median score: 4.3 vs. 6.3 in-sequence), equivalent to 2 less years of waiting time.

Conclusion

Two OPOs and a few Ktx centers are driving an Increase in OPO-initiated exceptions in kidney allocation. Although kidneys placed out-of-sequence were lower quality, the majority did not meet the traditional threshold for marginal kidneys. Without monitoring, increasing pressure to improve organ utilization risks increasing out-of-sequence allocation potentially exacerbating disparities in access to transplantation.