In the US in 2014, 17,188 potential kidneys were available from 8594 deceased donors (2014 SRTR/OPTN Annual Data Report). Of these, 25% were not recovered for transplant (8%) or were recovered but discarded (17%), in all 4277 discarded/not recovered (DNR) kidneys. The most common reason for non-recovery was poor organ function (40%) and for discard biopsy findings (34%). While discards may occur for sound medical reasons, a potential reason may be fear of poor outcomes resulting in regulatory review. At OPTN's request, SRTR analyzed the potential impact on program-specific outcome evaluations if DNR kidneys were transplanted. Donors January 1, 2012-June 20, 2014, were analyzed; 3090 not recovered and 6726 discarded kidneys were matched to transplanted kidneys by kidney donor risk index (KDRI). Programs that had transplanted a similar-KDRI kidney were assumed to have transplanted the DNR kidney into a similar recipient with similar outcomes. Once all DNR kidneys were matched to programs and recipients, the program-specific hazard ratio for first-year outcomes was re-calculated using the existing risk adjustment models, which explicitly adjust for KDRI and other donor risk factors, and compared to the program's hazard ratio on actual transplants. The risk adjustment models closely estimated expected events for DNR kidneys (Figure 1). Programs would see minimal change to their evaluations; about the same number would see improvement as would see decline (Figure 2). These findings may be more extreme than would occur in practice because 1) the risk adjustment models are recalibrated during each evaluation cycle, and 2) not 100% of DNR kidneys are likely suitable for transplant. This analysis suggests that transplanting currently discarded kidneys would not systematically affect program evaluations.

CITATION INFORMATION: Snyder J, Salkowski N, Thompson B, Wey A, Israni A, Kasiske B, Leppke S. Would Transplanting Kidneys Currently Being Discarded in the US Place Programs at Risk for Regulatory Review? Am J Transplant. 2016;16 (suppl 3).

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