*Purpose: Despite long candidate waiting times and a persistent supply to demand gap, less-than-ideal (LTI) kidneys continue to be underutilized in the U.S. Usage rates vary by center, and some centers may not have a consistently implemented practice of accepting such organ offers.

*Methods: In the context of a UNOS Labs organ offer simulation study, 89 surgeons and 65 physicians from 101 centers were surveyed in Sep 2018 and responded to the question, “How would you describe your center’s utilization of less-than-ideal kidneys (e.g., ECD, high KDPI)?” We examined the association between doctors’ reported vs. their center’s actual usage of LTI kidneys using OPTN data from Jan 2017-Sep 2018 and SRTR’s 2018 risk-adjusted acceptance rates.

*Results: 9.7% reported that their center “seldom” uses LTI kidneys; 29.9% “sometimes”; 34.4% “often”; 26% “very frequently.” 4 of 38 centers with multiple respondents had ratings differ by 2+ qualitative categories (e.g., “seldom” vs. “often”). A moderate degree of concordance was observed (Spearman’s ρ = 0.46, p<0.0001) between stated vs. actual center usage of ECD or KDPI>85% kidneys. Just 2 of 15 respondents who indicated their center “seldom” uses LTI kidneys were at a center that transplanted more than the national median of 10.6% of LTI kidneys. However, among respondents citing “often” or “very frequent” usage, 3% were at centers that performed 0 LTI transplants; 13% were at centers performing fewer than 5%; and 37% were at centers performing fewer than the national median. (Fig 1)

Among respondents citing “very frequent” usage, 18% were at centers with lower than average, risk-adjusted acceptance rates for KDRI>1.75 kidneys, per SRTR (Fig 2).

*Conclusions: Kidney clinicians’ perceptions of their program’s usage of LTI kidneys vary widely and may not always comport with reality. Some may not be aware of their center’s overarching philosophy (if one exists) on utilizing LTI kidneys, and practice may differ markedly among individual doctors at the same center. Kidney programs may benefit from introspective quality reviews and group discussions to reduce variation in offer acceptance practices.

« Back to 2020 American Transplant Congress