The shortage of deceased donor kidneys identified for potential transplantation in the United States is exacerbated by a high proportion of deceased donor kidneys being discarded after procurement. We estimated the impact of a policy proposal aiming to increase organ utilization by extending eligibility for waiting time reinstatement for recipients experiencing early allograft failure after transplantation. Decision analysis informed by clinical registry data. We used Organ Procurement and Transplantation Network data to identify 76,044 deceased-donor kidneys procured in the United States from 2013 to 2017, 80% of which were transplanted and 20% discarded. Extend waiting time reinstatement for recipients experiencing allograft failure from the current 90 days to 1 year after transplantation. Net impact to the waitlist, defined as the estimated number of additional transplants minus estimated increase in waiting list reinstatements. We estimated (1) the number of additional deceased donor kidneys that would be transplanted if there was a 5%-25% relative reduction in discards, and (2) the number of recipients who would regain waiting time under a 6-, 12-, 18-, and 24-month reinstatement policy. Reinstating a waiting time for recipients experiencing allograft failure up to 1 year after transplantation yielded more additional transplants than growth in additions to the waiting list for all model assumptions except the combination of a very low relative reduction in discards (5%) and a very high failure rate of transplanted kidneys that would previously have been discarded (≥5 times the rate of currently transplanted kidneys). Lack of empirical evidence supporting the proposed impact of such a policy change. A policy change reinstating waiting time for deceased donor kidneys recipients with allograft failure up to 1 year after transplantation should explored as a decision science–based intervention to improve organ utilization.

中文翻译：

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早期同种异体移植失败后延长恢复等待时间资格的影响：决策分析


在美国，大量已故捐献肾脏在获得后被丢弃，这加剧了美国可用于移植的已故捐献肾脏的短缺。我们估计了一项政策提案的影响，该政策提案旨在通过延长移植后经历早期同种异体移植失败的受者的等待时间恢复资格来提高器官利用率。根据临床登记数据进行决策分析。我们使用器官采购和移植网络数据来识别 2013 年至 2017 年在美国采购的 76,044 个已故捐献肾脏，其中 80% 被移植，20% 被丢弃。将经历同种异体移植失败的受者的等待恢复时间从目前的移植后 90 天延长至 1 年。对等候名单的净影响，定义为预计的额外移植数量减去预计恢复等候名单的增加。我们估计 (1) 如果废弃量相对减少 5%-25%，将要移植的额外死亡供体肾脏数量；(2) 在 6-、12- 的情况下重新获得等待时间的受者数量、18 个月和 24 个月的恢复保单。恢复移植后一年内经历同种异体移植失败的受者的等待时间，除了丢弃物相对减少量非常低（5％）和丢弃物相对减少量非常低（5％）和非常高的组合之外，除了所有模型假设的等待名单之外，还产生了比生长更多的额外移植物。先前应被丢弃的移植肾的失败率（≥当前移植肾失败率的5倍）。缺乏经验证据支持此类政策变化的拟议影响。 应探索政策变化，恢复同种异体移植失败的已故供肾受者在移植后长达 1 年的等待时间，作为一种基于决策科学的干预措施，以提高器官利用率。