Kidney non-procurement in solid organ donors in the United States.

There is limited data on the non-procurement of kidneys from solid organ donors. Analysis of Standard Transplant Analysis and Research files was undertaken on all deceased donors in the U.S. with at least one solid organ recovered. From 2000 to 2018, 21,731 deceased donor kidneys (averaging 1,144 kidneys per year) were not procured. No kidneys were procured from 8% of liver donors, 3% of heart donors, and 3% of lung donors. Compared to donors with all kidneys procured, those with none procured were older and more likely obese, black, hypertensive, diabetic, HCV+, smokers, PHS-IR designated, DCD, or deceased after CVA. While these donors had lower quality kidneys (median KDRI(IQR) 1.9(1.0) vs. 1.2(0.7)), there was substantial overlap in quality between non-procured and procured kidneys. Nearly one-third of non-procurements were attributed to donor history. Donors with elevated terminal creatinine likely resulting from AKI had higher odds of kidney non-procurement. Non-procurement odds varied widely across OPTN regions, with a positive correlation between donor kidney non-procurements and kidney discards at the DSA level. These findings suggest current discard rates underestimate the underutilization of deceased donor kidneys and more research is needed to optimize safe procurement and utilization of kidneys from donors with AKI.