title: A Re-evaluation of Discarded Deceased Donor Kidneys in the UK: Are Usable Organs Still Being Discarded?
abstract: A significant proportion of procured deceased donor kidneys are subsequently discarded. The UK Kidney Fast-Track Scheme (KFTS) was introduced in 2012, enabling kidneys at risk of discard to be simultaneously offered to participating centers. We undertook an analysis of discarded kidneys to determine if unnecessary organ discard was still occurring since the KFTS was introduced.
  
  
  
  Between April and June 2015, senior surgeons independently inspected 31 consecutive discarded kidneys from throughout the United Kingdom. All kidneys were biopsied. Organs were categorized as usable, possibly usable pending histology, or not usable for implantation. After histology reports were available, final assessments of usability were made.
  
  
  
  There were 19 donors (6 donations after brain death, 13 donations after circulatory death), with a median (range) donor age of 67 (29-83) years and Kidney Donor Profile Index of 93 (19-100). Reasons for discard were variable. Only 3 discarded kidneys had not entered the KFTS. After initial assessment postdiscard, 11 kidneys were assessed as usable, with 9 kidneys thought to be possibly usable. Consideration of histological data reduced the number of kidneys thought usable to 10 (10/31; 32%).
  
  
  
  The KFTS scheme is successfully identifying organs at high risk of discard, though potentially transplantable organs are still being discarded. Analyses of discarded organs are essential to identify barriers to organ utilization and develop strategies to reduce unnecessary discard.
authors: 1 Department of Nephrology and Transplantation, Guy's Hospital, London, United Kingdom. 2 Department of Histopathology, Guy's Hospital, London, United Kingdom. 3 Department of Surgery University of Cambridge, Cambridge, United Kingdom. 4 NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, United Kingdom.
authors: Shruti
authors: S
authors: Mittal
authors: Anna
authors: A
authors: Adamusiak
authors: Catherine
authors: C
authors: Horsfield
authors: Ioannis
authors: I
authors: Loukopoulos
authors: Nikolaos
authors: N
authors: Karydis
authors: Nicos
authors: N
authors: Kessaris
authors: Martin
authors: M
authors: Drage
authors: Jonathon
authors: J
authors: Olsburgh
authors: Christopher Je
authors: CJ
authors: Watson
authors: Chris J
authors: CJ
authors: Callaghan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003661:Decision Support Techniques; D046148:Donor Selection; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D015397:Program Evaluation; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D006113:United Kingdom