About three-quarters of those who need a kidney transplant in the U.S. will be offered at least one organ. But a significant proportion of those kidneys are turned down, according to a new study published in JAMA Network Open by researchers at Columbia University Irving Medical Center and Emory University.
Altogether, about 10,000 renal failure patients die every year waiting for a kidney, yet they received a median of 16 offers of donated organs.
The study suggested clinicians, not patients, are behind the bulk of the organ rejections, and their judgment may not always be sound.
In the 65 years since the first successful kidney transplant occurred, the operation has become routine with about 17,000 such procedures taking place in the U.S. every year. The JAMA study suggests about 10,000 patients die each year waiting for an organ, even though their medical team had rejected potential donor organs — often multiple times.
The researchers pored through the records of 14 million offers of kidneys for transplant made between 2008 and 2015 to more than 350,000 waitlisted patients. More than three-quarters received at least one offer for an organ. Of the 280,041 patients who received at least one offer, 30% — some 85,000 — either died while on the waitlist or were removed from it altogether. They received a first offer a median of 78 days after joining the list.
Study leader Sumit Mohan, a physician and associate professor of medicine at Columbia University Vagelos College of Physicians and Surgeons, noted the quality of the organ was the leading cause for rejecting an offer. However, the study focused only on organs that were eventually transplanted, suggesting they were suitable for the purpose of sustaining another human being.
"Presumably, these offers were declined primarily because centers were expecting patients to get a better offer in a timely manner," Mohan said in a statement. "In some cases, a decline may have been the right decision, but our data suggest that many others probably would have been better served if their transplant center had accepted one of the offers."
In most instances, a patient’s transplant team has one hour to decide to accept an organ. The decision to decline is often made without consulting with the patient, according to the study.
Mohan noted that "93% of transplanted kidneys are still working after one year and 75% are still working after five years, which calls into question the validity of these decisions to decline offers of a kidney."
Mohan suggested that improving patient engagement with the process would lead to fewer rejected organs. "It's better to get a less-than-perfect kidney sooner than to wait years for the perfect kidney to come along," he said. "Better communication between patients and transplant centers may prompt a reconsideration of how and when to decline offers."