What Did We Really Learn From the Collaborative? Is It In Our Best Interest to Use “Every Organ Every Time” in Kidney Transplantation?

Abstract

The Organ Donation Breakthrough Collaborative (ODBC) was formed in 2003 in response to a widening gap between the number of available organs and the number of patients wait listed for transplantation, as well as recognition of a potential to avail a large pool of donor organs. It made an immediate impact by increasing the number of donations and of organs procured. As the bulk of the organs came from an expanded donor pool, the impact on organ use varied somewhat. The discard rates for kidneys, a life-sustaining organ, increased significantly. A substantial effort to decrease organ discards has raised questions over whether Bevery organ every time^is in the best interest of kidney transplantation. This article is based on currently available data and reviews the circumstances that led to the formation of the ODBC and its short-and long-term impact on kidney transplantation. We question whether this is the right direction for the current situation and discuss whether there might be other potential avenues to pursue in bridging this divide.

Hand-assisted laparoscopic nephrectomy in a high risk overweight donor with left-sided IVC, and previous abdominal surgery

“…The chance of getting off the kidney transplant waiting list for the almost 95,000 patients with end stage renal disease awaiting a deceased donor organ in United States was estimated in 1:8 for the year 2018 [6]. Living donation is among the many efforts made to increase organ availability and timely transplantation [7]. However, given the organ scarcity, prospective donor rejection simply on account of technical difficulty does not seem justified nowadays.…”

Analysis of local versus imported expanded criteria donor kidneys: A single‐center experience with 497 ECD kidney transplants

“…Expanding the kidney pool has proven to be a formidable challenge, and the escalating disparity between organ supply and demand has fueled efforts not only to increase but also to maximize the utilization of available organs. This realization led to national initiatives such as the Organ Donor Breakthrough Collaborative and to the implementation of the ECD policy in 2002 . These efforts resulted in increase in the number of marginal donors such as ECDs.…”

“…In October, 2002, the United Network for Organ Sharing (UNOS), in conjunction with the Organ Donor Breakthrough Collaborative, introduced the expanded criteria donor (ECD) policy and concept . In addition, the “every organ, every time” philosophy promoted by these initiatives led to increases in organ recovery from “marginal” donors including ECDs and donation after cardiac death (DCD) donors . Coincident with these changes in deceased donor organ recovery in the United States (US), the kidney discard rate virtually doubled in the subsequent “ECD era.” At present, nearly 20% of recovered kidneys are not transplanted, accounting for almost 2700 discards annually, of which more than half are from ECDs …”

Eversion endarterectomy of the deceased donor renal artery to prevent kidney discard

“…One of the major challenges in organ transplantation today is the disparity between kidney supply and demand, which has been described as an insurmountable problem. To increase the size of the pool of donors, initiatives such as the Organ Donor Breakthrough Collaborative and other national initiatives were implemented . As a result of these endeavors, an upturn in the number of “marginal” donors such as expanded criteria donors (ECD), donation after cardiocirculatory death (DCD) donors, donors with prolonged warm or cold ischemia time (CIT), dual kidneys from donors at the extremes of age, or donors with acute kidney injury (AKI) occurred .…”

“…To increase the size of the pool of donors, initiatives such as the Organ Donor Breakthrough Collaborative and other national initiatives were implemented. 8,9 As a result of these endeavors, an upturn in the number of "marginal" donors such as expanded criteria donors (ECD), [10][11][12] donation after cardiocirculatory death (DCD) donors, 13,14 donors with prolonged warm or cold ischemia time (CIT), [15][16][17][18][19] dual kidneys from donors at the extremes of age, 20,21 or donors with acute kidney injury (AKI) occurred. [22][23][24] Commensurate with efforts 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 increased from 10% in 1998 to 20% in 2017.…”