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Patients on waiting list as US centers refuse to donate

Numerous options for providing dialysis patients with the availability of a donor kidney are missed daily in the United States, as transplant centers often reject organs. New research results.

The results were published online Aug. 30 in JAMA Open by dr. med. S. Ali Husain from the Columbia University Medical Center in New York City and colleagues.

"Investigators report that every year between January 2008 and December 2015, approximately 10,000 potential candidates who received at least one organ donation for a deceased donor kid died or were removed from the waiting list without receiving a transplant. [19659002] Worse yet, those who died and were waiting for a kidney received an average of 1

6 offers, while on average they were on the waiting list for 651 days.

Patients did not usually know that. These offers were made in their name because the transplant centers usually do not discuss deals for a donor kidney which are rejected with potential recipients, primarily for time reasons.

"Honestly, we were surprised by the results. Sumit Mohan, associate professor of medicine at Vagelos College of Physicians and Surgeons Columbia University, New York City, reported Medscape Medical News .

Not Just Patients The problem is that a significant part of them are waiting for an organ.

While Transplant Centers Endeavor to Provide the Patient with the Optimal Organ For deceased patients, the right choice would be to take an imperfect kidney, "Mohan pointed out.

Ten patients used to have kidney disease every day [ColumbiaUniversityInvestsinitsStudyFollowingarefusalbyatransplantcentertoacceptanofferfordeceaseddonorkidneysonitsbehalfthealligatorssetouttoseehowthewaitingkidneytransplantcandidateswouldwork[19659003] They used the United Network for Organ Sharing (UNOS) dataset, which contains an ordered list of all matching kidney transplant candidates and deceased donor kidneys.

Importantly, the current analysis excluded all kidneys that were eventually discarded (a French study created by Medscape Medic al News was released earlier this week, showing that in the US, deceased donor kidneys are twice as likely to be discarded as in France.)

The final cohort included 280,041 adults who were waiting for a kidney transplant and at least one allograft during the 8-year study interval at the transplant center.

The median time that the patients listed at the time of dialysis for kidney transplantation was 1.2 years. The median follow-up was 755 days from the time the patients were placed on the waiting list.

"An average of 10 candidates who had previously received an offer [for a donor kidney] died each day during the study period," report Mohan and colleagues. 19659016] More than 80% of kidneys initially rejected as centers are waiting for "ideal" organs

The median time between centers receiving their first donor organ supply for those next eligible for kidney was just 48 days after the patient was first put on the waiting list, the authors report.

Patients who had actually received a kidney transplant from a deceased donor had a median of 17 offers while on the waiting list for a median of 422 days before actually receiving the transplant.

] "Similarly … those who were dropped from the waiting list received an average of 15 quotes … while they were on the waiting list," the authors add.

Overall, 84% of deceased donor kidneys were rejected for one or more potential donor recipients before they were admitted to transplantation.

Approximately 27% of all transplanted kidneys were rejected for all potential donors in the center's donor area, leading to their use outside their designated geographical area.

Mohan warned, however, that the quality of the data showing the reasons for rejecting kidney supply is relatively poor.

"According to the centers, the quality of the organs or donors accounted for … 92.6% of all rejected offers," said the investigators. "While offers were rarely rejected due to patient-related factors (2.6%), logistical limitations (0.5%) or other concerns."

Importantly, all donor kidney transplants were ultimately transplanted in the current analysis. Somebody waiting for an allograft somewhere in the US was at the bottom of the waiting list mappings system.

"These are all kidneys that someone else has used with good results, so we do not talk about kidneys that were unremarkable." I think the problem is that the transplant centers believe they will get a better kidney without to take into account what a patient experiences during dialysis, "he said] And he added," The likelihood that a patient will be dead if the center is an 'ideal' Kidney is much higher than some centers believe. "

The authors also found significant geographical differences in the risk of dying on the kidney transplant waiting list after the centers had received at least one donation for the next higher candidate. In terms of the lowest risk of mortality, Maine had the best performance at country level on candidates after the transplant center had received a donor kidney bid.

In addition, the median number of offers that the transplant center made prior to the death of the candidates varied Waiting list received between 11 and 74 offers depending on the state.

Decisions taken under pressure, but more transparency required

Mohan stressed that transplant centers are under considerable pressure to make swift decisions a donor kid accepts w or not when one becomes available.

You only have 60 minutes to decide whether to take a kidney or not. If they refuse, the same kidney can be offered to the next patient on the list.

"That means there's really no time for it. I have a joint decision with the patient," he noted.

However, Mohan continues to believe there is an urgent need to increase transparency about which type of donor organ transplant centers accept in terms of donor organ quality.

"I think patients have a right to know because it could change where they are listed for a donor organ," he suggested.

Second, patients have a right, if a center rejects an organ to know about this rejection. Englisch: www.mjfriendship.de/en/index.php?op…95&Itemid=55 […] The adverse effects of prolonged pre-transplant dialysis exposure on post-transplantation outcomes would have even those candidates who have had a terrible time dialysis eventually allografts were likely to experience better survival and a better quality of life if they had accepted an earlier offer.

Earlier transplantation occurs, although there is evidence that obtaining lower quality kidney provides most candidates with survival and quality of life benefits over a permanent waiting list.
Or Mohan repeats, "It's better to get a smaller number of kidneys." Mohan has reported that he has received grants from the National Institutes of H's health and personal fees from the Health Services Advisory Group, the Centers for Medicare & Medicaid Services, Angion and Kidney International Reports.

JAMA Open. Published online on August 30, 2019. Full text

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