Kidney transplantation (KT) is a superior alternative to dialysis for many patients with
respect to longevity, quality of life, morbidity, and the cost of End-Stage Renal Disease (ESRD) care. However,
of the 95,000 patients waitlisted for a KT in 2017, less than 20,000 received a KT. In the same year, about
4,000 patients died, while another 4,700 were removed from the waitlist because they were considered too sick
to transplant. Despite the long waitlist, more than 3,500 (19%) of the deceased donor kidneys were discarded.
“No Recipient Found” was the stated reason for discarding 1,325 of the donated kidneys. The discard rate
increases significantly for the low-quality kidneys, reaching as high as 60% for the kidneys in the lowest quality
decile. This discard occurs even though many discarded kidneys, even those in the lowest quality decile, would
have conferred significant survival benefits to some recipients relative to remaining on dialysis.
The current kidney allocation system does not efficiently allocate kidneys at high risk of discard. The
patient prioritization algorithm does not quickly identify patients who will benefit most from such kidneys, and
the donated kidneys are wasted. Improvements to the kidney allocation system are needed to reduce the
number of discarded kidneys while allocating them equitably to patients who would most benefit. However,
revising allocation policy is challenging because patients and transplant professionals must weigh the risks and
benefits of accepting a low-quality kidney against the risks of waiting for a much higher quality kidney. The
transplant community and patient preferences in accepting low-quality kidneys are unknown.
The Project aims are as follows:
Aim 1: Identify Viable Fast-Tracking Algorithms for Kidneys at Risk of Discard
Aim 2: Develop a Computer Simulation Engine Implementing Kidney Fast-Tracking Algorithms
Aim 3: Evaluate and Compare Results from the Simulation Engine using Preference Tradeoffs