In the USA, nearly one in five donated kidneys (3,159) recovered with intent to transplant were discarded in 2015. This is happening despite nearly 100,000 patients waiting for a transplant, 22 dying every day, and over 600,000 patients with end-stage renal disease that would benefit from a transplant. Why in the hell don't more get transplanted? Here are the top 5 reasons we found:
- Increased recovery of bad kidneys - The kidney donor criteria and the pool has expanded immensely to include recovery of more marginal kidneys which has increased the number of both transplants and discards.
- Risk aversion of transplant centers - Program-specific reports measuring a center's transplant outcomes, though well risk-adjusted, still concern some centers that feel they are on disadvantaged due to unadjusted confounders.
- Ran out of time - The process takes too long and a recipient is not found before the kidney accumulates too many hours of cold ischemia time and the organ is discarded. The proverbial game of hot potato.
- No recipient located/Transplant list exhausted - All transplant candidates were considered and denied the kidney offer.
- Misleading diagnostic tests - Increased biopsy rates have increased discard rates despite not being reliable.
Stewart, D. E., Garcia, V. C., Rosendale, J. D., Klassen, D. K., & Carrico, B. J. (2017). Diagnosing the Decades-Long Rise in the Deceased Donor Kidney Discard Rate in the United States, 101(3). https://doi.org/10.1097/TP.0000000000001539
