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 End-of-Life Care among US Adults with ESKD Who Were Waitlisted or Received a Kidney Transplant, 2005–2014

2020 ◽  
Vol 31 (10) ◽  
pp. 2424-2433
Author(s):  
Catherine R. Butler ◽  
Peter P. Reese ◽  
James D. Perkins ◽  
Yoshio N. Hall ◽  
J. Randall Curtis ◽  
...  
Keyword(s):  
United States ◽  
End Of Life ◽  
Kidney Transplant ◽  
End Of Life Care ◽  
Reference Group ◽  
Deceased Donor ◽  
The United States ◽  
Life Care ◽  
Advance Care ◽  
Functioning Kidney

BackgroundThe care of patients in the United States who have ESKD is often shaped by their hopes and prognostic expectations related to kidney transplant. Little is known about how patients’ engagement in the transplant process might relate to patterns of end-of-life care.MethodsWe compared six measures of intensity of end-of-life care among adults in the United States with ESKD who died between 2005 and 2014 after experiencing differing exposure to the kidney transplant process.ResultsOf 567,832 decedents with ESKD, 27,633 (5%) had a functioning kidney transplant at the time of death, 14,653 (3%) had a failed transplant, 16,490 (3%) had been removed from the deceased donor waitlist, 17,010 (3%) were inactive on the waitlist, 11,529 (2%) were active on the waitlist, and 480,517 (85%) had never been waitlisted for or received a transplant (reference group). In adjusted analyses, compared with the reference group, patients exposed to the transplant process were significantly more likely to have been admitted to an intensive care unit and to have received an intensive procedure in the last 30 days of life; they were also significantly more likely to have died in the hospital. Those who died on the transplant waitlist were also less likely than those in the reference group to have been enrolled in hospice and to have discontinued dialysis before death.ConclusionsPatients who had engaged in the kidney transplant process received more intensive patterns of end-of-life care than other patients with ESKD. These findings support the relevance of advance care planning, even for this relatively healthy segment of the ESKD population.

Clinical Management of Kidney Transplant Recipients

2019 ◽  
pp. 457-459
Author(s):  
James A. Onigkeit
Keyword(s):  
United States ◽  
Transplant Recipient ◽  
Kidney Transplant ◽  
Clinical Management ◽  
Living Donor ◽  
Kidney Transplant Recipient ◽  
Deceased Donor ◽  
The United States ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

Kidney transplant is common. More than 19,000 kidney transplants were performed in the United States in 2017. About two-thirds were deceased donor transplants, and about one-third were living donor transplants. The clinical management of a kidney transplant recipient begins in the operating room. Posttransplant complications can be divided into 2 categories: surgical and medical.

scholarly journals SO032THE DISCARD AND DECLINE OF HEPATITIS C VIRUS POSITIVE DONOR KIDNEYS IN THE UNITED STATES

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Tarek Alhamad ◽  
Krista Lentine ◽  
David Axelrod ◽  
Sami Abdulnabi ◽  
Mark Schnitzler ◽  
...  
Keyword(s):  
United States ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Organ Procurement ◽  
Deceased Donor ◽  
The United States ◽  
Odds Ratios ◽  
Life Saving ◽  
Increasing Trend ◽  
Donor Characteristics

Abstract Background and Aims With more transplant centers in the United States are accepting hepatitis C virus infected (HCV+) deceased donor kidneys (dHCV+), the trend of non-utilization and decline of these organs have not been re-examined. Method We used data from the national Organ Procurement and Transplantation Network on deceased donor kidneys between Jan 2000 and Dec 2018 in the United States. Kidney non-utilization for HCV+ was defined as a positive donor HCV status and positive hepatitis as the reason for non-utilization. dHCV+ kidney decline was defined as a donor HCV+ status among kidneys recovered for transplantation but not transplanted. We assessed associations of a dHCV+ status with kidney non-utilization or decline, adjusted for donor characteristics (age, race, sex, body mass index, diabetes, hypertension, kidney donor profile index), using multivariable logistic regression. Results A total of 274,570 deceased donor kidneys procured for transplantation between 2000 and 2018 were identified. Among these kidneys, 4.1% were from dHCV+. Proportion of dHCV+ non-utilization among all non-utilized kidneys increased from 2000-2005 (3.9%) and then subsequently declined. This proportion increased slightly to 1.1% in 2014 and decreased to 0.5, 0.8, 0.4, 0.6% in 2015-2018, respectively. Multivariable-adjusted odds ratios for dHCV+ non-utilization and decline by year demonstrate consistently an increasing trend from 2000-2006 followed by a decreasing trend from 2006-2011 (Fig A-B). Multivariable-adjusted odds ratios for dHCV+ (compared to dHCV-) non-utilization and decline increased to 6.56 (95% CI 5.30-8.12) and 6.66 (95% CI 5.39-8.24), respectively, in 2012, and decreased to 2.32 (95% CI 2.01-2.69) and 2.28 (95% CI 1.98-2.64), respectively, in 2018. Conclusion dHCV+ non-utilization and decline have decreased in the last few years, particularly after 2014. 2018 had a historic lowest odds ratio for non-utilization and decline of dHCV+ organs, which reflects the increased acceptability of transplant centers to these kidneys. Overall, since 2014, the odds ratios for dHCV+ non-utilization and decline decreased by half. Yet, there is more room for decreasing the non-utilization and decline for these potentially life-saving organs.

scholarly journals The Drug Overdose Epidemic and Deceased-Donor Transplantation in the United States

2018 ◽  
Vol 168 (10) ◽  
pp. 702 ◽  
Author(s):  
Christine M. Durand ◽  
Mary G. Bowring ◽  
Alvin G. Thomas ◽  
Lauren M. Kucirka ◽  
Allan B. Massie ◽  
...  
Keyword(s):  
United States ◽  
Drug Overdose ◽  
Deceased Donor ◽  
The United States

scholarly journals How Inaccurate Metrics Hide the True Potential for Organ Donation in the United States

2018 ◽  
Vol 28 (1) ◽  
pp. 12-18 ◽  
Author(s):  
Laura A. Siminoff ◽  
Heather M. Gardiner ◽  
Maureen Wilson-Genderson ◽  
Teresa J. Shafer
Keyword(s):  
United States ◽  
Organ Donation ◽  
Organ Procurement ◽  
Secondary Analysis ◽  
The United States ◽  
Transplant Recipients ◽  
Donor Pool ◽  
Conversion Rates ◽  
The Us ◽  
Brain Dead

Background: There is a discrepancy between the reported increase in donor conversion rates and the number of organs available for transplant. Methods: Secondary analysis of data obtained from the Scientific Registry of Transplant Recipients from January 2003 through December 2015 was performed. The primary outcomes were the (1) number of brain-dead donors from whom solid organs were recovered and (2) number of the organs transplanted. Descriptive statistics and growth plots were used to examine the trajectory of organ donation, recovery, and transplantation outcomes over the 11-year period. Results: From 2003 to 2006, the number of brain-dead donors increased from 6187 to 7375, remaining relatively stable at approximately 7200 thereafter. The average eligible deaths per organ procurement organization dropped from 182.7 (standard deviation [SD]: 131.3) in 2003 to 149.3 (SD: 111.4) in 2015. This suggests a total of 12 493 unrealized potential donors (2006-2015). Conclusions: Since 2006, a steady decline in the number of donor-eligible deaths was reported. In 2003, the reported eligible deaths was 11 326. This number peaked in 2004 at 11 346, tumbling to 9781 eligible donors in 2015, despite a 9% increase in the US population. From 2006 to 2015, the data indicate an artificial depression and underestimation of the true potential of brain-dead donors in the United States of conservatively 12 493 donors or 39 728 missing organs. New metrics providing objective but verifiable counts of the donor pool are needed.

scholarly journals Deceased donor organ procurement injuries in the United States

2016 ◽  
Vol 6 (2) ◽  
pp. 423 ◽  
Author(s):  
Tim E Taber ◽  
Nikole A Neidlinger ◽  
Muhammad A Mujtaba ◽  
Elling E Eidbo ◽  
Roxane L Cauwels ◽  
...  
Keyword(s):  
United States ◽  
Organ Procurement ◽  
Deceased Donor ◽  
The United States ◽  
Donor Organ

scholarly journals Economic Considerations in Using HCV and HIV Positive Donors for Kidney Transplant

2021 ◽  
Vol 05 (04) ◽  
pp. 1-1
Author(s):  
Aniruddha Bhattacharyya ◽  
◽  
Lee R. Friedman ◽  
Beje S. Thomas ◽  
Coleman I. Smith ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Hiv Infections ◽  
Deceased Donor ◽  
The United States ◽  
Opioid Use ◽  
Donor Pool ◽  
Socioeconomic Impacts ◽  
Novel Method ◽  
Stage Renal Disease ◽  
End Stage

End Stage Renal Disease is becoming more prevalent in the United States of America, with demand for kidney transplant exceeding the available organ supply. A novel method to increase the donor pool has been to consider transplanting organs from deceased patients who have had Hepatitis C Virus (HCV) or Human Immunodeficiency Virus (HIV) infections. Transplants with HCV infected kidneys are becoming more prevalent, due to increased organ supply due to increased mortality from injection opioid use. Similarly, deceased donor transplants using kidneys infected with HIV have become more common following the passage of the “HIV Organ Policy Equity (HOPE) Act” in 2013. These novel transplant strategies present distinct socioeconomic impacts which differ from those of prior transplant practices. Here, we have reviewed the costs and benefits of receiving a kidney transplant from deceased donors infected with HIV or HCV, compared to receiving a non-viremic kidney transplant.

Sign in / Sign up

Export Citation Format

Share Document