Wednesday, May 10, 2017

recovering more deceased donor kidneys

Here's a post from the American Society of Neprology (ASN):
Old Age Should Not Exclude Organ Donation After Death
Kidneys from elderly deceased individuals can function for years after transplantation
"New research suggests that age cut-offs for deceased organ donors prevent quality kidneys from being available to patients in need of life-saving transplants. A study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN) found that even kidneys from donors ≥80 years of age can function for years after transplantation."
The article, entitled “Long-term Outcomes and Discard Rate of Kidneys by Decade of Extended Criteria Donor Age,” will appear online at on December 15, 2016, doi:10.2215/CJN.05990616. 

And from the journal Transplantation
Diagnosing the Decades-Long Rise in the Deceased Donor Kidney Discard Rate in the U.S.  by Stewart, Darren E. M.S., UNOS; Garcia, Victoria C. M.P.H., UNOS; Rosendale, John D. M.S., UNOS; Klassen, David K. M.D., UNOS; Carrico, Bob J. Ph.D., UNOS

"Abstract--Background: The proportion of deceased donor kidneys recovered for transplant but discarded increased steadily in the U.S. over 2 decades, from 5.1% in 1988 to 19.2% by 2009. Over 100,000 patients are waiting for a kidney transplant, yet 3,159 kidneys were discarded in 2015.

"Results: This study found that at least 80% of the discard rate rise can be explained by the recovery of kidneys from an expanding donor pool and changes in biopsy and pumping practices. However, a residual discard rate increase could not be explained by changes in these factors. From 1987 to 2009, median donor age rose from 26 to 43 years; median KDRI increased from 1.1 to 1.3. Our findings suggest the increase from 10% to 30% in the proportion of kidneys pumped during the 2000's served as a buffer keeping the discard rate from rising even higher than it did.

"Conclusions: The majority of the kidney discard rate rise can be explained by the broadening donor pool. However, the presence of an unexplained, residual increase suggests behavioral factors (e.g., increased risk aversion) and/or allocation inefficiencies may have played a role. Reducing risk aversion, improving allocation, and more often pumping less-than-ideal, yet potentially transplantable kidneys, may help reverse the trend."

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