Background

Prior living donors (PLDs) receive very high priority on the kidney (KI) waiting list (WL). Programs must submit requests for PLD priority to the UNOS Organ Center, which processes them w/in 1 business day. Programs' delays in submitting requests can affect timely access to transplantation (TX). This study's purpose was to characterize the timeliness of adding PLDs to the WL, requesting PLD priority, and activating on the WL.

Methods

OPTN and CMS data were used to examine timing of activation on the WL and requests for PLD priority relative to listing date. There were 210 PLDs (221 registrations) added to the KI WL between 1/01/10 and 7/31/15. As of 9/4/15, 168 were removed from the WL because they received a DD TX, 6 received LD TX, 2 died, 5 were too sick to TX, and 29 were still waiting.

Results

40.7% of PLDs (N=90) were listed pre-emptively; 6 of these PLDs began dialysis between listing and TX. Of the 131 non-pre-emptive PLD registrations, median time between starting chronic dialysis and listing was 338 days (range=3-4934). 6.8% of PLDs were listed w/in 3 mths of initiation of dialysis, 25.3% w/in 3-12 mths, 12.2% w/in 1-2 yrs, and 14.9% >2 yrs after initiation.

Median time waiting in active status before receiving PLD priority was 2 days (range:0-1450); 67.4% of PLDs received PLD priority w/in 7 days of activation, but 15.3% waited 8-30 days, 8.1% waited 31-90 days, 4.1% waited 3-12 mths, and 5.0% waited >1 yr for PLD priority.

Median total time in inactive status was 3 days (range=0-2020). 68.3% of PLDs were inactive for <90 days, 17.6% for 3-12 mths, 8.6% for 1-2 yrs, and 5.4% for >2 yrs. For the 31 PLD registrations (14.0%) that were inactive >1 yr, 21 inactivations were due to incomplete work-up, 2 to candidate choice, 2 were temporarily too well, 1 had insurance issues, 1 was temp. too sick, 2 were due to incomplete work-up plus being temp. too sick, 1 was due to work-up plus insurance issues, and 1 had an inappropriate weight and medical non-compliance.

Conclusions

Many PLDs are exposed to months or years on dialysis before being added to the WL. After listing, most PLDs receive PLD priority and active status in a timely manner, but a substantial number are spending time in active status without PLD priority or a large amount of time in inactive status, which affects their access to timely TX. Increased awareness of the benefit of timely listing and the process for obtaining PLD priority is needed. Researchers must consider this issue when interpreting PLD outcomes after listing.

CITATION INFORMATION: Wainright J, Kucheryavaya A, Klassen D, Stewart D. Are Prior Living Kidney Donors with ESRD Being Listed and Receiving Transplantation Priority in a Timely Manner? Am J Transplant. 2016;16 (suppl 3).

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