Influence of kidney offer acceptance behavior on metrics of allocation efficiency

Andrew Wey, Nicholas Salkowski, Bertram L. Kasiske, Ajay K. Israni, Jon J. Snyder

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

We investigated associations of deceased donor kidney offer acceptance with likelihood of the kidney being discarded, cold ischemia time at transplant (CIT), and likelihood of the kidney being exported outside the donation service area (DSA). We used kidney offers from donors in the Scientific Registry of Transplant Recipients July 1, 2015-June 30, 2016, and a stratified logistic regression to estimate odds ratios of acceptance for candidates wait-listed in a DSA. We estimated associations between these ratios and likelihood of discard or export and CIT at transplant. Approximately 0.50 kidneys were discarded per donor; lower DSA-specific offer acceptance ratios were associated with more discards (R=-0.20; P=0.006). For a median donor, the DSA with the highest acceptance ratio would place 0.12 more kidneys per donor than the DSA with the lowest ratio. Low acceptance ratios were associated with higher CIT (R=-0.23; P<0.001). For the median donor, CIT was 2.9 hours shorter for the DSA with the highest versus lowest acceptance ratio. Low acceptance ratios were associated with more exports (R=-0.43; P<0.001); the probability was 15% higher for a median donor in the DSA with the lowest versus highest acceptance ratio. Improving lower-than-expected offer acceptance would likely reduce discards, CIT, and exports.

Original languageEnglish (US)
JournalClinical Transplantation
DOIs
StateAccepted/In press - 2017

Keywords

  • Cold ischemia time
  • Deceased donor
  • Kidney transplant
  • Organ offers

PubMed: MeSH publication types

  • Journal Article

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