Unintended Consequences in Use of Increased Risk Donor Kidneys in the New Kidney Allocation Era

Transplant Proc. 2018 Jan-Feb;50(1):14-19. doi: 10.1016/j.transproceed.2017.11.025.


Background: The new kidney allocation system (KAS) intends to allocate the top 20% of kidneys to younger recipients with longer life expectancy. We hypothesized that the new KAS would lead to greater allocation of Public Health Service (PHS) increased-risk donor organs to younger recipients.

Methods: Analyses of the Organ Procurement and Transplantation Network data of patients who underwent primary deceased kidney transplantation were performed in pre- and post-KAS periods.

Results: The allocation of PHS increased-risk kidney allografts in various age groups changed significantly after implementation of the new KAS, with an increased proportion of younger individuals receiving increased-risk kidneys (7% vs 10% in age group 20-29 y and 13% vs 18% in age group 30-39 y before and after KAS, respectively; P < .0001). This trend was reversed in recipients 50-59 years old, with 31% in the pre-KAS period compared with 26% after KAS (P < .0001).

Conclusions: The new KAS resulted in a substantial increase in allocation of PHS increased-risk kidneys to candidates in younger age groups. Because increased-risk kidneys are generally underutilized, future efforts to optimize the utilization of these organs should target younger recipients and their providers.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Female
  • Humans
  • Kidney Transplantation / standards
  • Kidney Transplantation / statistics & numerical data*
  • Male
  • Middle Aged
  • Risk Factors
  • Tissue Donors / supply & distribution*
  • Tissue and Organ Procurement / methods*
  • Transplants / standards
  • Transplants / statistics & numerical data*