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

20 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)
Article numbere13057
JournalClinical Transplantation
Volume31
Issue number9
DOIs
StatePublished - Sep 2017

Bibliographical note

Funding Information:
This work was conducted under the auspices of the Minneapolis Medical Research Foundation, contractor for the Scientific Registry of Transplant Recipients, as a deliverable under contract number HHSH250201500009C (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). As a US Government-sponsored work, there are no restrictions on its use. The views expressed herein are those of the authors and not necessarily those of the US Government. AKI was partially supported by R01 HS 24527. The authors thank Scientific Registry of Transplant Recipients colleague Nan Booth, MSW, MPH, ELS, for manuscript editing.

Publisher Copyright:
Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Keywords

  • cold ischemia time
  • deceased donor
  • kidney transplant
  • organ offers

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