Abstract: SA-OR075
Who Gets Skipped? Characterizing Within-Center Placement of Out-of-Sequence Deceased-Donor Kidneys
Session Information
- Transplantation: Clinical Controversies in Donation, Access, Monitoring, and Treatment
November 08, 2025 | Location: Room 370A, Convention Center
Abstract Time: 04:50 PM - 05:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Tucker, Emma Grace, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States
- Yu, Miko, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, United States
- Adler, Joel Thomas, The University of Texas at Austin Dell Medical School, Austin, Texas, United States
- Cron, David C., New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, United States
- Schold, Jesse D., University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, United States
- Mohan, Sumit, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, United States
- Husain, Syed Ali, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, United States
Group or Team Name
- CURE Lab.
Background
Deceased-donor kidney (DDK) allocation is intended to follow a ranked match-run of potential recipients. However, organ procurement organizations (OPOs) are increasingly bypassing this sequence and allocating kidneys “out-of-sequence” (OOS) to transplant centers, which choose which of their candidates receives the DDK. We analyzed “list-diving” within individual transplant centers.
Methods
Using 2021-2023 SRTR data, we identified the 5 transplant centers that received the most OOS kidneys. For each OOS transplant, we assessed how far down the local match-run the kidney was placed. Within centers, we compared skipped vs non-skipped patients and examined outcomes among skipped patients.
Results
At the five highest-volume OOS transplant centers, the top-priority patient received the OOS kidney in only 35 of 1,598 (2%) cases, and the median recipient was ranked 23rd on the institutional match-run. Skipped patients were younger (56 vs 63 years, p<0.01) and had more dialysis exposure (24 vs 17 months, p<0.01) than non-skipped patients. Fewer than half of skipped patients received a DDK transplant later in the study period, and those who did received a kidney with a median KDPI 13% higher than their best skipped offer. Longer wait times after being skipped were associated with receipt of higher-KDPI kidneys.
Conclusion
List-diving within high-volume OOS transplant centers is highly prevalent. Younger candidates and those with longer dialysis durations are more likely to be skipped. Most skipped candidates are later removed from the waitlist without a transplant, die on the waitlist, or are transplanted with a lower quality kidney. As OOS allocation rises, understanding transplant center decision-making is essential.
Funding
- NIDDK Support