Transplant program offer acceptance behavior varies substantially for kidneys after 100 previous offers (i.e., “hard-to-place offers”). An organ procurement organization (OPO) offer acceptance report could help OPOs place these kidneys by identifying the programs most likely to accept and transplant them. An offer acceptance model was developed with offers from match runs that ended in acceptance from January 1, 2015, to December 31, 2015. The model adjusts for candidate and donor factors, including the number of previous offers, to estimate the expected acceptance probability for each offer. Each kidney transplant program was then categorized into one of five tiers ranging from above average to below average acceptance basedon the posterior distribution estimated from observed and expected acceptances for hard-to-place kidneys. Programs in the above average tier accepted kidneys for and performed 1006 transplants compared with 144.6 expected acceptances, while programs in the below average category accepted kidneys for and performed 148 transplants compared with 974.5 expected acceptances (Table 1). Thus, 30 programs transplanted 68% of the 1466 transplanted hard-to-place kidneys despite receiving only 11.9% of the 1,127,295 hard-to-place offers. Figure 1 illustrates a potential OPO offer acceptance report that may help inform OPOs of the substantial differences in offer acceptance behavior for hard-to-place kidneys and, within the confines of OPTN policy, help reduce discards and increase transplants by informing the OPOs of programs most likely to accept and transplant hard-to-place kidneys.

CITATION INFORMATION: Wey A, Salkowski N, Kasiske B, Israni A, Snyder J. An OPO Offer Acceptance Report for Hard-to-Place Kidneys. Am J Transplant. 2017;17 (suppl 3).

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