Organ utilization – the next hurdle in transplantation?

Abstract

Summary Nonutilization of organs from consented deceased donors remains a significant factor in limiting patient access to transplantation. Critical to reducing waste is a clear understanding of why organs are not used: accurate metrics are essential to identify the extent and causes of waste but use of these measures as targets or comparators between units/jurisdictions must be done with caution as focus on any one measure may result in unintended adverse consequences. Comparison between centres or countries may be misleading because of variation in definitions, patient or graft characteristics. Two of the most challenging areas to improve appropriate deceased donor organ utilization are appetite for risk and lack of validated tools to help identify an organ that will function appropriately. Currently, the implanting surgeon is widely considered to be accountable for the use of a donated organ so guidelines must be clear to allow and support sensible decisions and recognition that graft failure or inadvertent disease transmission are not necessarily attributable to poor decision‐making. Accepting an organ involves balancing risk and benefit for the potential recipient. Novel technologies such as machine perfusion may allow for more robust guidance as to the functioning of the organ.

Dual kidney transplants from adult marginal donors: Review and perspective

“…Commensurate with initiatives to enlarge the donor pool and with changes in the Kidney Allocation System (KAS) including implementation of the Kidney Donor Profile Index (KDPI), the kidney discard rate in the United States increased from 10% in 1998 to 21% in 2020 7,148–157 . Kidney discard or non‐utilization has been identified as a growing problem in other countries and transplant networks as well 158–165 . Unfortunately, the US appears to have amongst the highest kidney discard rates in the world 148–164 .…”

“…7,[148][149][150][151][152][153][154][155][156][157] Kidney discard or non-utilization has been identified as a growing problem in other countries and transplant networks as well. [158][159][160][161][162][163][164][165] Unfortunately, the US appears to have amongst the highest kidney discard rates in the world. [148][149][150][151][152][153][154][155][156][157][158][159][160][161][162][163][164] A number of potential solutions to the "discard crisis" have been proposed, some of which involve "rescue allocation" with DKT.…”

Risk Aversion, Organ Utilization and Changing Behavior

“…However, the success or failure of this approach will be influenced by the overall risk appetite of the unit. Wider consultation may paradoxically lead to higher decline rates due to a dilution of clinical responsibility and a form of “ regression towards the mean ” ( 16 ).…”

“…Surgery must occur in adequately resourced and supported environments, with exact requirements varying between centers. This includes optimizing numbers of surgeons, physicians, allied health professionals, operating theatres, intensive care facilities, inpatient and outpatient follow-up facilities ( 16 ). This is unlikely to be achieved without significant monetary investment so other strategies (e.g., collaborative networks, shared decision-making, etc.)…”

3D Bioprinting of Vascularized Tissues for in vitro and in vivo Applications

“…Not only are organ donors a limited resource, the functional efficacy of donated organs as well as risk of disease and/or infection (a prominent issue during the COVID-19 pandemic) from deceased individuals greatly limit the number of available tissues for transplantation ( Neuberger and Callaghan, 2020 ; Shah et al, 2020 ). Living donors, although providing another small pool of organs or partial organs, still do not keep up with the current demand ( Lee et al, 2019c ).…”