Deceased Organ Donation Ethical Considerations Living Donor Research

Why Recovered Deceased Donor Kidneys Are Discarded

One of the dirty secrets of the so-called organ shortage is the number of deceased donor kidneys recovered but not utilized (aka ‘discarded’). OPTN acknowledged this issue a couple of years ago when they proposed major kidney allocation changes, and closer examination of the issues has continued since.

The authors examined the national records from January 1, 2007 through March 31, 2012. During that time, 16,892 kidneys were recovered from 8499 deceased donors. 13,998 were discarded. [note: the abstract says 19.75% of all recovered kidneys were discarded, so I think 16,892 is the number of deceased donors who had at least one recovered kidney discarded].

The most common reason for discarding a recovered kidney was ‘biopsy findings’ at 39.01%, followed by ‘other’ at 15.9%. ‘Other’ meant either multiple reasons for discard, or reasons that were not available as DonorNet drop down options [note: seems to me, donornet needs to be improved, because ‘other’ provides no real data].

My biggest concern, however, is for the 1933 kidneys that were discarded because of ‘no recipient’ or ‘list exhausted’. Is it really possible there were no suitable recipients for nearly 2000 kidneys, or is this a symptom of our inefficient regional allocation system? How many of these kidneys would’ve found a home if OPOs and transplant centers were less motivated by their own self-interest ($$ as well as prioritizing one’s patients and facility) and the organs immediately were offered to the “best” would-be recipient, regardless of where s/he lived?

During that same period 264 kidneys were discarded because they were left ‘on ice’ or ‘on the pump’ for too long. Recovered kidneys are only viable for a certain amount of time. How many of those kidneys would’ve been utilized if all transplant centers across the country were made aware the organs were available immediately, rather than after the local and regional would-be recipients were eliminated?

I encourage everyone to click the link below and view the entire chart.
Full Abstract:

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