Abstract: SA-OR104
Out-of-Sequence Placement of Deceased Donor Kidneys Is Exacerbating Inequities
Session Information
- Late-Breaking Science Orals - 2
October 26, 2024 | Location: Room 6C, Convention Center
Abstract Time: 05:40 PM - 05:50 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Mohan, Sumit, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, United States
- Yu, Miko, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, United States
- Husain, Syed Ali, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, United States
- Adler, Joel Thomas, Dell Seton Medical Center at The University of Texas, Austin, Texas, United States
- Maclay, Lindsey, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, United States
- Schold, Jesse D., University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
Background
Deceased donor kidney allocation in the US follows an objective algorithm that is designed to balance equity & utility. Organ procurement organizations (OPOs) have the ability to circumvent this system & are increasingly turning to out-of-sequence (OOS) allocation of organs, allowing them to allocate at their own discretion.
Methods
Using SRTR transplant registry & offer data from 2020-23, we identified all organ offers for deceased donor kidneys, including those placed OOS. We examined the prevalence of OOS allocation, using Gini coefficients as a measure of inequality at the center level.
Results
From 2020 to 2023, OOS allocation increased nearly 9-fold, from 342 to 2,882 kidneys, representing 1 in 7 deceased donor kidney transplants – including kidneys across the quality spectrum (Figure 1). By 2023, 91% of OPOs were using OOS allocation. Only 14 transplant centers accounted for a third of all OOS transplants, creating a system-wide inequity that is reflected in the persistently high Gini coefficient despite the rapid OOS increase (Table 1). OOS recipients include a greater proportion of older, white & male recipients as well as those with private insurance & preemptive patients.
Conclusion
There has been a sharp increase in OOS allocation of deceased donor kidneys across the spectrum of organ quality. Most of these kidneys are being placed at a small number of transplant centers, creating preferential access to transplantation for a subset of patients & exacerbating patient & system-level inequities in access to transplantation.
Gini coefficients for all OPOs and transplant centers, ranging from 0 (perfect equality) to 1 (perfect inequality)
| Center Type | Year | In-sequence Gini | Out-of-sequence Gini |
| OPO | 2020 | 0.31 | 0.89 |
| 2021 | 0.31 | 0.65 | |
| 2022 | 0.32 | 0.53 | |
| 2023 | 0.32 | 0.47 | |
| Transplant center | 2020 | 0.49 | 0.93 |
| 2021 | 0.50 | 0.82 | |
| 2022 | 0.48 | 0.78 | |
| 2023 | 0.48 | 0.72 |
Funding
- NIDDK Support