Bottom Line: This observational study used United Network for Organ Sharing data to examine how wait-listed kidney transplant candidates fared after deceased donor kidneys were offered but declined by transplant centers on patients' behalf. The study included 280,041 wait-listed patients who received at least one donor kidney offer between 2008 and 2015. Among the patients, 81,750 received a deceased donor kidney transplant; 30,870 received a kidney from a living donor; 25,967 died on the waiting list; 59,359 were removed from the waiting list; and 82,095 remained on the waiting list. Most kidneys (84 percent) were declined on behalf of at least one candidate before eventually being accepted for transplant into other patients with lower priority on the match list. Concerns over organ or donor quality accounted for about 93 percent of all declined donor kidney offers. Study authors report patients who received a deceased donor kidney had a median of 17 organ offers before transplant, those who died on the waiting list had a median of 16 offers, and those who were removed from the list had a median of 15 organ offers. The study estimates that overall 10 patients with at least one previous offer of a donor kidney died each day during the study period. The odds of dying on the waiting list after receiving an offer of a kidney varied across the United States. The results suggest declined deceased donor kidney offers appear to be missed opportunities for transplants for some patients. Limitations of the study include a lack of detail for reasons reported by transplant centers for declining organ offers and limited data since 2014 when the criteria for prioritizing patients for certain organs changed.
Authors: Sumit Mohan, M.D., M.P.H., Columbia University Irving Medical Center, New York, and coauthors
(doi:10.1001/jamanetworkopen.2019.10312)
Editor's Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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Media advisory: To contact corresponding author Sumit Mohan, M.D., M.P.H., email Helen Garey, M.P.H., at hbg3@cumc.columbia.edu. The full study is linked to this news release.
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