Abstract: PO2104
Increasing Frequency of Kidneys Allocated Out of Sequence by Organ Procurement Organizations
Session Information
- Transplantation: Clinical - Allocation, Evaluation, Prognosis, and Viral Onslaughts
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
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.