ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on Twitter

Kidney Week

Abstract: PO2104

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

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical


  • 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

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.


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.


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.


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.