TY - JOUR
T1 - Kidney utilization in the Netherlands - do we optimally use our donor organs?
AU - Schutter, Rianne
AU - Vrijlandt, Willemijn A L
AU - Weima, Gelske M
AU - Pol, Robert A
AU - Sanders, Jan-Stephan F
AU - Crop, Meindert J
AU - Leuvenink, Henri G D
AU - Moers, Cyril
N1 - © The Author(s) 2022. Published by Oxford University Press on behalf of the ERA.
PY - 2023/3
Y1 - 2023/3
N2 - BACKGROUND: To ensure optimal utilization of deceased donor kidneys, it is important to understand the precise reasons why kidneys are discarded. In this study, we aimed to obtain a comprehensive overview of kidney utilization and discard during the entire donation process in the Netherlands.METHODS: In this retrospective cohort study we analyzed kidney utilization of 3856 kidneys in the Netherlands between 1 January 2015 and 31 December 2020. For every kidney that was not transplanted, we determined the moment of and reason for discard through a unique case-by-case assessment.RESULTS: Kidney discard according to the traditional definition (procured but not transplanted) was 7.8%. However, when kidneys that seemed medically suitable at the beginning of the donation process were also included, many more potential donor kidneys were lost and the total non-utilization was 24.4%. Subjectively presumed impaired organ quality was responsible for 34.2% of all discarded kidneys. Two-thirds of kidneys discarded due to acute kidney injury (AKI), had only AKI stage 1 or 2.CONCLUSION: The classical definition of organ discard underestimates the non-utilization of deceased donor kidneys. Strategies to improve kidney utilization could be a revision of the maximum allowed agonal time in donation after circulatory death, careful consideration in reporting and accepting kidneys from donors with AKI, and a prospectively filled registry of detailed organ discard reasons, including the 'silent' non-utilization before procurement.
AB - BACKGROUND: To ensure optimal utilization of deceased donor kidneys, it is important to understand the precise reasons why kidneys are discarded. In this study, we aimed to obtain a comprehensive overview of kidney utilization and discard during the entire donation process in the Netherlands.METHODS: In this retrospective cohort study we analyzed kidney utilization of 3856 kidneys in the Netherlands between 1 January 2015 and 31 December 2020. For every kidney that was not transplanted, we determined the moment of and reason for discard through a unique case-by-case assessment.RESULTS: Kidney discard according to the traditional definition (procured but not transplanted) was 7.8%. However, when kidneys that seemed medically suitable at the beginning of the donation process were also included, many more potential donor kidneys were lost and the total non-utilization was 24.4%. Subjectively presumed impaired organ quality was responsible for 34.2% of all discarded kidneys. Two-thirds of kidneys discarded due to acute kidney injury (AKI), had only AKI stage 1 or 2.CONCLUSION: The classical definition of organ discard underestimates the non-utilization of deceased donor kidneys. Strategies to improve kidney utilization could be a revision of the maximum allowed agonal time in donation after circulatory death, careful consideration in reporting and accepting kidneys from donors with AKI, and a prospectively filled registry of detailed organ discard reasons, including the 'silent' non-utilization before procurement.
U2 - 10.1093/ndt/gfac300
DO - 10.1093/ndt/gfac300
M3 - Article
C2 - 36318454
SN - 0931-0509
VL - 38
SP - 787
EP - 796
JO - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
IS - 3
ER -