title: New Solutions to Reduce Discard of Kidneys Donated for Transplantation.
abstract: Kidney transplantation is a cost-saving treatment that extends the lives of patients with ESRD. Unfortunately, the kidney transplant waiting list has ballooned to over 100,000 Americans. Across large areas of the United States, many kidney transplant candidates spend over 5 years waiting and often die before undergoing transplantation. However, more than 2500 kidneys (>17% of the total recovered from deceased donors) were discarded in 2013, despite evidence that many of these kidneys would provide a survival benefit to wait-listed patients. Transplant leaders have focused attention on transplant center report cards as a likely cause for this discard problem, although that focus is too narrow. In this review, we examine the risks associated with accepting various categories of donated kidneys, including discarded kidneys, compared with the risk of remaining on dialysis. With the goal of improving access to kidney transplant, we describe feasible proposals to increase acceptance of currently discarded organs.
authors.affiliation: Renal-Electrolyte and Hypertension Division, Department of Biostatistics and Epidemiology and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; and peter.reese@uphs.upenn.edu.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Reese
authors.affiliation: Renal Division, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Meera N
authors.initials: MN
authors.lastname: Harhay
authors.affiliation: Department of Surgery, and.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Abt
authors.affiliation: Department of Surgery, and.
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Levine
authors.affiliation: Department of Biostatistics and Epidemiology and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; and Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Scott D
authors.initials: SD
authors.lastname: Halpern
mesh_terms: D006801:Humans; D016030:Kidney Transplantation; D017744:Medical Waste Disposal; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000592:standards* / Q000706:statistics & numerical data*
chemical_list: D017744:Medical Waste Disposal
keywords: epidemiology and outcomes; kidney transplantation; outcomes