Transplant centers in the United States have a habit of turning down deceased donor kidneys on behalf of their patients, many of whom eventually die waiting for a kidney—without knowing that their centers passed on a potential transplant, according to a recent study.
What’s more, those same transplant centers later accept the same kidneys for patients lower on the waitlist, leaving the researchers to question why the kidneys weren’t considered viable for higher-priority patients in the first place.
The study, published in JAMA Network Open, included 280,041 people on kidney transplant waitlists from 2008 to 2015. The researchers found that during that time, 9.3 percent (25,967) of patients on the waitlist died after each received an average of 16 kidney offers that the centers turned down on their behalf. This turns out to be an average of 10 people who died per day waiting for a kidney during the study period after the transplant center turned down a prior offer. Another 21.2 percent (59,359) of patients, who unknowingly received an average of 15 offers, were eventually removed from the list because they no longer met the criteria for a transplant.
The patients who died were more likely to be older or have diabetes or a vascular condition, and had not started dialysis prior to being waitlisted.
Why were the donor kidneys rejected? Transplant centers said it was because they were waiting for kidneys that were healthier or from younger donors. But the researchers pointed out that doing so resulted in the deaths of patients who could have benefited from the rejected kidneys in the same way other lower-priority patients eventually did—with outcomes that were no worse than those in people who received “better” kidneys. In fact, evidence shows that the earlier a kidney is transplanted—even if the kidney is of marginal quality—the better the recipent’s chances of survival and quality of life compared with if they received a healthier kidney at a later date.
What you should do
If you’re on a kidney waitlist and concerned that a viable donor kidney may be declined on your behalf, consider asking your transplant team to explain how they decide whether to accept or reject a kidney for you. You can find out if their values and preferences align with yours and discuss any concerns you might have about their decision making. Not all transplant centers have the same criteria, so you may also ask to be waitlisted at multiple centers.
This article first appeared in the December 2019 issue of UC Berkeley Health After 50.
Also see Don't Let Kidney Disease Sneak Up on You.