title: Developing organ offer and acceptance measures: when 'good' organs are turned down.
abstract: Turndowns of offers of deceased donor kidneys for transplantation can contribute to inefficiencies in the organ distribution system and inequality in access to donated organs. Match run data were obtained for 4967 'good' kidneys placed and transplanted in 2005 after fewer than 50 offers. These kidneys were not recovered from donation after cardiac death or expanded criteria donors, or from donors with a history of substance abuse. On average, these good kidneys were not accepted until after seven offers to candidates and after offers to 2.4 programs. Models for the likelihood of acceptance found several donor and candidate characteristics to be significantly related to acceptance rates (p < 0.05). After accounting for these variables, there remained 2- to 3-fold differences among transplant programs in acceptance rates. These models could be used to identify kidney transplant centers with exceptional acceptance practices. Several strategies might be employed to increase acceptance rates for good organs.
authors.affiliation: Scientific Registry of Transplant Recipients, Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA. Robert.Wolfe@ArborResearch.org
authors.forename: R A
authors.initials: RA
authors.lastname: Wolfe
authors.forename: F B
authors.initials: FB
authors.lastname: LaPorte
authors.forename: A M
authors.initials: AM
authors.lastname: Rodgers
authors.forename: E C
authors.initials: EC
authors.lastname: Roys
authors.forename: G
authors.initials: G
authors.lastname: Fant
authors.forename: A B
authors.initials: AB
authors.lastname: Leichtman
mesh_terms: D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data*; D008487:Medical History Taking; D018579:Patient Selection; D016019:Survival Analysis; D009927:Tissue and Organ Procurement / Q000379:methods / Q000592:standards*; D016896:Treatment Outcome