The following is a summary of “Characterization of Transplant Center Decisions to Allocate Kidneys to Candidates With Lower Waiting List Priority,” published in the June 2023 issue of Nephrology by King et al.

For a study, researchers aimed to represent the frequency and practice of the transplant centers to allocate the kidneys to the patients ranked lower at their center.

Investigators used the organ data from US transplant centers and directly connected with a local organ procurement organization. Study included deceased kidney donors who underwent a single match run and had at least one kidney transplanted locally from March 1, 2022, to March 28, 2023, data were analyzed. 

The preliminary focus of the study was the high-priority patient (defined as transplanted after zero declines for local candidates in the match-run) versus the lower-priority patient.

 They reported 26,579 organ donations from 3,136 donors (median [IQR] age, 38 [25-51] years; 2,903 [62%] men) to 4,668 recipients. The center skipped the highest-ranked patients to place kidneys in the low-ranked patients in the match run for 3,169 kidneys (68%). These kidneys went to a median (IQR) of the 4th- (3rd- to 8th-) ranked candidate. Higher kidney donor profile index (KDPI; higher score indicates lower quality). 

The score showed that only 24% of kidneys with a KDPI of at least 85% were allocated to the top-ranked candidates, while 44% of kidneys with a KDPI of 0% to 20% were allocated to the top-ranked candidates.

Investigators reported that kidneys were transplanted to recipients with varying estimated posttransplant survival (EPTS) scores, both worse and better than the scores of skipped patients, in all kidney donor profile index (KDPI) risk groups.

Through this study, they proposed an algorithm to enhance the kidney allocation process.

Source: jamanetwork.com/journals/jamanetworkopen/fullarticle/2805570?resultClick=1