title: Poor organ quality and donor-recipient age mismatch rather than poor donation rates account for the decrease in deceased kidney transplantation rates in a Germany Transplant Center.
abstract: Kidney transplantation is limited not by technical or immunological challenges but by lack of donor organs. Whereas the number of patients on waiting list increased, the transplantation rate decreased. We analyzed the development of decline rates and reasons as well as the fate of declined organs. In total, 1403 organs offered to 1950 patients between 2001 and 2010 were included. Of 440 organs offered between 2009 and 2011 that were declined, we investigated whether these organs were transplanted elsewhere and requested delayed graft function, creatinine, graft and patient survival. Data were compared to results of transplantations at the same time at our center. Decline rate increased from 47% to 87%. Main reasons were poor organ quality and donor-recipient age or size mismatch. Of the rejected organs, 55% were transplanted at other centers with function, graft and patient survival equivalent to patients transplanted at our center during that period. The number of decline has increased over time mainly due to a growing number of marginal donors accounting for poor organ quality or a mismatch of donor and recipient. If proper donor-recipient selection is performed, many organs that would otherwise be discarded can be transplanted successfully.
authors.affiliation: Department of Surgery, University of Freiburg, Freiburg, Germany; Department of Surgery, University of Lübeck, Lübeck, Germany.
authors.forename: Dietlind
authors.initials: D
authors.lastname: Tittelbach-Helmrich
authors.forename: Christian
authors.initials: C
authors.lastname: Thurow
authors.forename: Stephan
authors.initials: S
authors.lastname: Arwinski
authors.forename: Christina
authors.initials: C
authors.lastname: Schleicher
authors.forename: Ulrich T
authors.initials: UT
authors.lastname: Hopt
authors.forename: Dirk
authors.initials: D
authors.lastname: Bausch
authors.forename: Oliver
authors.initials: O
authors.lastname: Drognitz
authors.forename: Przemyslaw
authors.initials: P
authors.lastname: Pisarski
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D046148:Donor Selection; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*
keywords: kidney transplantation; organ donation; shortage of organs