Introduction: Despite the severe organ shortage, nearly 20% of all deceased donor kidneys procured in the United States are discarded annually. Wait times for kidney transplant vary significantly geographically and may be influenced by organ acceptance practices. How these practices influence waitlist deaths is not known currently. We examined the geographical variation in waitlist deaths for individuals who had received a prior organ offer that was declined.

Methods: Using data from the United Network for Organ Sharing Potential Transplant Recipient file, we identified adult kidney transplant candidates who had a previous organ offer in 2015 that was declined and have subsequently died without having received a transplant. Logistic Regression was used to calculate the odds of waitlist death for individuals who received an offer that was declined, by state, and the odds of waitlist death after adjusting for candidate EPTS.

Results: Among the 96,269 adult candidates who received an offer in 2015, 5,737 (5.96%) candidates died on the waitlist. The mean EPTS was 52 (± 24.6) for candidates who died on the waitlist. The odds of death after receiving an offer for an organ ranged from 0.27 to 1.69 (adjusted odds ranged from 0.23 to 1.74). The adjusted odds of death in our cohort was highest in Montana and lowest in Alaska.

Conclusion: There are significant geographic disparities in waitlist deaths among candidates who were previously offered a kidney, even after accounting for recipient characteristics. This suggests geographic variation in organ selectivity practices, and underscores the negative consequences for patients when organ offers are declined. These findings suggest that organ offer acceptance and decline should be a consideration in policy making for effective allocation and utilization of available organs.

CITATION INFORMATION: Winterhalter F., Husain S., Patzer R., Pastan S., Mohan S. Geographic Variation in Deceased Donor Kidney Waitlist Deaths after Declining an Organ Offer Am J Transplant. 2017;17 (suppl 3).

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