The Washington, D.C. Experience with Uncontrolled Donation after Circulatory Determination of Death: Promises and Pitfalls

2008 ◽  
Vol 36 (4) ◽  
pp. 735-740 ◽  
Author(s):  
Jimmy A. Light
Keyword(s):  
Organ Procurement ◽  
Organ Donor ◽  
Deceased Donor ◽  
The United States ◽  
Demand And Supply ◽  
Deceased Donor Kidney ◽  
Donor Population ◽  
History Of ◽  
Expanded Criteria

As of January 1, 2008, over 98,000 people are waiting for organ transplants in the United States of America. Of those, nearly 75,000 are waiting for a kidney. In this calendar year, fewer than 15,000 will receive a kidney transplant from a deceased donor. The average waiting time for a deceased donor kidney now exceeds five years in virtually all metropolitan areas. Sadly, nearly as many people die waiting as there are deceased donors each year, despite monumental efforts by the entire transplant community to increase both the number of organ donors and the number of organs recovered from each donor. The imbalance between demand and supply has led to considerable efforts to expand the criteria for what is considered an acceptable organ donor by the Organ Procurement and Transplant Network (OPTN), thereby hoping somewhat to assuage the shortfall of donor organs. So-called Expanded Criteria Donors (ECDs) may be older than 50, have history of hypertension, or have died from intracerebral hemorrhage and/or have impaired renal function. ECDs now make up nearly 40% of the donor population.

State-by-State Use of AMA Guides

2019 ◽  
Vol 24 (5) ◽  
pp. 3-7, 16
Keyword(s):  
Expert Testimony ◽  
Narrow Range ◽  
The United States ◽  
Workers Compensation ◽  
Federal Employees ◽  
Permanent Disability ◽  
Sixth Edition ◽  
History Of ◽  
Canadian Provinces

Abstract This article presents a history of the origins and development of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), from the publication of an article titled “A Guide to the Evaluation of Permanent Impairment of the Extremities and Back” (1958) until a compendium of thirteen guides was published in book form in 1971. The most recent, sixth edition, appeared in 2008. Over time, the AMA Guides has been widely used by US states for workers’ compensation and also by the Federal Employees Compensation Act, the Longshore and Harbor Workers’ Compensation Act, as well as by Canadian provinces and other jurisdictions around the world. In the United States, almost twenty states have developed some form of their own impairment rating system, but some have a narrow range and scope and advise evaluators to consult the AMA Guides for a final determination of permanent disability. An evaluator's impairment evaluation report should clearly document the rater's review of prior medical and treatment records, clinical evaluation, analysis of the findings, and a discussion of how the final impairment rating was calculated. The resulting report is the rating physician's expert testimony to help adjudicate the claim. A table shows the edition of the AMA Guides used in each state and the enabling statute/code, with comments.

12 Month Outcomes of Expanded Criteria Deceased Donor Kidney Transplants.

2014 ◽  
Vol 98 ◽  
pp. 594
Author(s):  
S. Turner ◽  
C. Callaghan ◽  
J. Olsburgh ◽  
N. Mamode ◽  
M. Drage ◽  
...  
Keyword(s):  
Deceased Donor ◽  
Kidney Transplants ◽  
Donor Kidney ◽  
Deceased Donor Kidney ◽  
Expanded Criteria

Effect of the Opioid Crisis on the Donor Pool for Kidney Transplantation: An Analysis of National Kidney Deceased Donor Trends from 2010–2016

2018 ◽  
Vol 47 (2) ◽  
pp. 84-93 ◽  
Author(s):  
Donald F. Chute ◽  
Meghan E. Sise
Keyword(s):  
United States ◽  
Kidney Transplant ◽  
Drug Overdose ◽  
Organ Procurement ◽  
Deceased Donor ◽  
The United States ◽  
Hcv Infection ◽  
Kidney Donor ◽  
Donor Pool ◽  
Opioid Crisis

Background: The opioid crisis has led to a dramatic increase in the number of drug overdose deaths in the United States. Little is known about the effect of the opioid crisis on the kidney transplant donor pool, particularly on hepatitis C virus (HCV)-infected donors. Methods: This is a retrospective analysis of the data from the Organ Procurement and Transplantation Network from 2010 to 2016. We determined the changes in characteristics of kidney transplant donors and evaluated which changes may be directly related to the opioid crisis. Results: Between 2010 and 2016, we found a 26% increase in overall donors, including a 277% increase in the number of donors who died from drug overdose. Nineteen percent of donors who died of drug overdose had HCV infection. Donors who die from drug overdose and donors with HCV infection are younger, less likely to have diabetes or hypertension, and have favorable kidney donor profile index scores compared to average donors. Despite these favorable characteristics, HCV-infected donors appear to be notably underutilized, with substantially lower kidneys per donor being transplanted compared to HCV uninfected donors. Conclusion: The opioid crisis in the United States has substantially altered the kidney donor pool. Strategies to increase utilization of all potentially viable kidneys for transplant are needed, particularly in this era of new, highly effective, direct-acting antiviral therapy for HCV infection.

scholarly journals Regional Disparities in Transplantation With Deceased Donor Kidneys With Kidney Donor Profile Index Less Than 20% Among Candidates With Top 20% Estimated Post Transplant Survival

2019 ◽  
Vol 29 (4) ◽  
pp. 354-360 ◽  
Author(s):  
S. Ali Husain ◽  
Kristen L. King ◽  
Geoffrey K. Dube ◽  
Demetra Tsapepas ◽  
David J. Cohen ◽  
...  
Keyword(s):  
United States ◽  
Research Question ◽  
Deceased Donor ◽  
The United States ◽  
Strongly Correlated ◽  
Kidney Donor ◽  
Donor Kidney ◽  
Transplant Survival ◽  
Post Transplant ◽  
Deceased Donor Kidney

Introduction: The Kidney Allocation System in the United States prioritizes candidates with Estimated Post-Transplant Survival (EPTS) ≤20% to receive deceased donor kidneys with Kidney Donor Profile Index (KDPI) ≤20%. Research Question: We compared access to KDPI ≤ 20% kidneys for EPTS ≤ 20% candidates across the United States to determine whether geographic disparities in access to these low KDPI kidneys exist. Design: We identified all incident adult deceased donor kidney candidates wait-listed January 1, 2015, to March 31, 2018, using United Network for Organ Sharing data. We calculated the proportion of candidates transplanted, final EPTS, and KDPI of transplanted kidneys for candidates listed with EPTS ≤ 20% versus >20%. We compared the odds of receiving a KDPI ≤ 20% deceased donor kidney for EPTS ≤ 20% candidates across regions using logistic regression. Results: Among 121 069 deceased donor kidney candidates, 28.5% had listing EPTS ≤ 20%. Of these, 16.1% received deceased donor kidney transplants (candidates listed EPTS > 20%: 17.1% transplanted) and 12.3% lost EPTS ≤ 20% status. Only 49.4% of transplanted EPTS ≤ 20% candidates received a KDPI ≤ 20% kidney, and 48.3% of KDPI ≤ 20% kidneys went to recipients with EPTS > 20% at the time of transplantation. Odds of receiving a KDPI ≤ 20% kidney were highest in region 6 and lowest in region 9 (odds ratio 0.19 [0.13 to 0.28]). The ratio of KDPI ≤ 20% donors per EPTS ≤ 20% candidate and likelihood of KDPI ≤ 20% transplantation were strongly correlated ( r 2 = 0.84). Discussion: Marked geographic variation in the likelihood of receiving a KDPI ≤ 20% deceased donor kidney among transplanted EPTS ≤ 20% candidates exists and is related to differences in organ availability within allocation borders. Policy changes to improve organ sharing are needed to improve equity in access to low KDPI kidneys.

scholarly journals Reproducibility of Deceased Donor Kidney Procurement Biopsies

2020 ◽  
Vol 15 (2) ◽  
pp. 257-264 ◽  
Author(s):  
S. Ali Husain ◽  
Kristen L. King ◽  
Ibrahim Batal ◽  
Geoffrey K. Dube ◽  
Isaac E. Hall ◽  
...  
Keyword(s):  
Interstitial Fibrosis ◽  
Organ Procurement ◽  
Deceased Donor ◽  
Event Analysis ◽  
Time To Event ◽  
Allograft Survival ◽  
Donor Kidney ◽  
Tubular Atrophy ◽  
Deceased Donor Kidney ◽  
Probability Of Death

Background and objectivesUnfavorable histology on procurement biopsies is the most common reason for deceased donor kidney discard. We sought to assess the reproducibility of procurement biopsy findings.Design, setting, participants, & measurementsWe compiled a continuous cohort of deceased donor kidneys transplanted at our institution from 1/1/2006 to 12/31/2016 that had at least one procurement biopsy performed, and excluded cases with missing biopsy reports and those used in multiorgan transplants. Suboptimal histology was defined as the presence of advanced sclerosis in greater than or equal to one biopsy compartment (glomeruli, tubules/interstitium, vessels). We calculated κ coefficients to assess agreement in optimal versus suboptimal classification between sequential biopsy reports for kidneys that underwent multiple procurement biopsies and used time-to-event analysis to evaluate the association between first versus second biopsies and patient and allograft survival.ResultsOf the 1011 kidneys included in our cohort, 606 (60%) had multiple procurement biopsies; 98% had first biopsy performed at another organ procurement organization and their second biopsy performed locally. Categorical agreement was highest for vascular disease (κ=0.17) followed by interstitial fibrosis and tubular atrophy (κ=0.12) and glomerulosclerosis (κ=0.12). Overall histologic agreement (optimal versus suboptimal) was κ=0.15. First biopsy histology had no association with allograft survival in unadjusted or adjusted analyses. However, second biopsy optimal histology was associated with a higher probability of death-censored allograft survival, even after adjusting for donor and recipient factors (adjusted hazard ratio, 0.50; 95% confidence interval, 0.34 to 0.75; P=0.001).ConclusionsDeceased donor kidneys that underwent multiple procurement biopsies often displayed substantial differences in histologic categorization in sequential biopsies, and there was no association between first biopsy findings and post-transplant outcomes.

Allocation of Indivisible Life-Saving Goods With Both Intrinsic and Relational Quality: The New Deceased-Donor Kidney Allocation System

2016 ◽  
Vol 51 (1) ◽  
pp. 140-169
Author(s):  
David L. Weimer ◽  
Laura Wilk
Keyword(s):  
Organ Procurement ◽  
Deceased Donor ◽  
Relational Quality ◽  
Allocation System ◽  
Original Proposal ◽  
Life Saving ◽  
Deceased Donor Kidney ◽  
Kidney Allocation System ◽  
Intrinsic Quality

Allocation of scarce heterogeneous life-saving goods confronts society with profound challenges that are analytically complex and morally laden. Deceased-donor kidneys for transplant are heterogeneous in terms of relational and intrinsic quality. In 2014, the Organ Procurement and Transplantation Network implemented a new allocation system that more explicitly takes account of intrinsic quality. We trace the evolution of the new allocation system with particular attention to the role of evidence and the ways that concerns about equity were solicited, assessed, and taken into account in modifying the original proposal. These deliberations show the potential for stakeholder rulemaking to integrate evidence and values.

scholarly journals A Donor Utilization Index to Assess the Utilization and Discard of Deceased Donor Kidneys Perceived as High Risk

2019 ◽  
Vol 14 (11) ◽  
pp. 1634-1641 ◽  
Author(s):  
Corey Brennan ◽  
Syed Ali Husain ◽  
Kristen L. King ◽  
Demetra Tsapepas ◽  
Lloyd E. Ratner ◽  
...  
Keyword(s):  
High Risk ◽  
Regional Variation ◽  
Organ Procurement ◽  
Deceased Donor ◽  
Level Variation ◽  
Donor Kidney ◽  
Perceptions Of Risk ◽  
Deceased Donor Kidney ◽  
Number Of Patients ◽  
Donor Characteristics

Background and objectivesAn increasing number of patients on the waitlist for a kidney transplant indicates a need to effectively utilize as many deceased donor kidneys as possible while ensuring acceptable outcomes. Assessing regional and center-level organ utilization with regards to discard can reveal regional variation in suboptimal deceased donor kidney acceptance patterns stemming from perceptions of risk.Design, setting, participants, & measurementsWe created a weighted donor utilization index from a logistic regression model using high-risk donor characteristics and discard rates from 113,640 deceased donor kidneys procured for transplant from 2010 to 2016, and used it to examine deceased donor kidney utilization in 182 adult transplant centers with >15 annual deceased donor kidney transplants. Linear regression and correlation were used to analyze differences in donor utilization indexes.ResultsThe donor utilization index was found to significantly vary by Organ Procurement and Transplantation Network region (P<0.001), revealing geographic trends in kidney utilization. When investigating reasons for this disparity, there was no significant correlation between center volume and donor utilization index, but the percentage of deceased donor kidneys imported from other regions was significantly associated with donor utilization for all centers (rho=0.39; P<0.001). This correlation was found to be particularly strong for region 4 (rho=0.83; P=0.001) and region 9 (rho=0.82; P=0.001). Additionally, 25th percentile time to transplant was weakly associated with the donor utilization index (R2=0.15; P=0.03).ConclusionsThere is marked center-level variation in the use of deceased donor kidneys with less desirable characteristics both within and between regions. Broader utilization was significantly associated with shorter time to transplantation.

Sign in / Sign up

Export Citation Format

Share Document