Subject(s)
Tissue and Organ Procurement/statistics & numerical data , Transplantation/statistics & numerical data , Cadaver , Heart Transplantation/statistics & numerical data , Heart Transplantation/trends , Heart-Lung Transplantation/trends , Humans , Intestines/transplantation , Liver Transplantation/statistics & numerical data , Liver Transplantation/trends , Living Donors/statistics & numerical data , Pancreas Transplantation/statistics & numerical data , Pancreas Transplantation/trends , Survival Analysis , Survivors , Time Factors , Tissue Donors/statistics & numerical data , Tissue and Organ Procurement/trends , Transplantation/mortality , Transplantation/trends , United States , Waiting ListsABSTRACT
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.