Patients who die waiting for a kidney, or who are removed from the transplant waitlist for poor health, are usually considered unfortunate victims of the shortage of available organs. Yet a new Columbia study has found that most candidates have had multiple opportunities to receive a transplant, but the offered organs were declined by their transplant team and subsequently transplanted in someone lower on the waitlist. The findings are in JAMA Network Open.
Nearly one-third of the candidates died or were removed from the list without receiving a transplant. Candidates who died without a transplant received a median of 16 offers while waitlisted.
“Presumably, these offers were declined primarily because centers were expecting patients to get a better offer in a timely manner,” says study leader Dr. Sumit Mohan, associate professor of epidemiology at Columbia University Mailman School of Public Health and associate professor of medicine at Columbia Vagelos College of Physicians & Surgeons.
“Our data suggest that many others probably would have been better served if their transplant center had accepted one of the offers.”
Dr. Mohan and colleagues examined all 14 million kidney offers made between 2008 and 2015 to more than 350,000 waitlisted patients in the U.S. The data came from the United Network for Organ Sharing.
The analysis revealed that most waitlisted patients — 76 percent — received at least one viable offer of a kidney.
Of the 280,041 patients who received at least one offer, 30 percent (85,000 people) either died on the waitlist or were removed from the waitlist before receiving a kidney. The vast majority of organs included those that appeared to be an ideal immunological match.
For the most part, Dr. Mohan says, patients are unaware of declined offers.Friday Letter Submission, Publish on September 06