Despite an urgent demand for kidney donors in the U.S, about one in four donor kidneys goes unused. In 2022, more than 71,000 people were on the kidney transplant waiting list, with waitlists often extending as long as five years for a donor kidney.
Recent research from the University of Minnesota School of Public Health found that many kidneys considered to be of "acceptable quality" are never used. These "acceptable" kidneys often come from donors who score lower on clinical and diagnostic measures such as older age at death, obesity, hypertension, diabetes and other health factors. Rather than continuing to discard these kidneys, University researchers explored how they could help older adults with kidney failure to live longer, healthier lives.
To conduct the study, the team created a simulated model of adults aged 65 or older who were on the kidney transplant waiting list. The researchers tracked this simulated population of 100,000 people, following their potential waiting list and post-transplant outcomes over the remainder of their lifetimes. Then, researchers tested what would happen if transplant centers increased the rate of transplantation by between 5% and 25% compared with current practices using acceptable-quality donor kidneys.
The study, published in JAMA Network Open, found:
- More transplants led to fewer deaths. Increasing the use of acceptable-quality kidneys by 25% was linked to about 141 fewer deaths per 10,000 people on the transplant waiting list.
- Better health at a reasonable cost. Increasing the use of acceptable-quality kidneys improved both the length and quality of life for older patients. At a cost of about $8,100 for each additional quality-adjusted life year gained, the policy produced extra years of healthy life at a very low cost compared with most health interventions.
- Potential overall cost savings. When researchers included the time patients and caregivers spend receiving and providing care, the strategy not only improved health but also saved about $10,200 per patient on average.
"Too many kidneys that could help patients are going unused," said Matthew Kaufmann, lead author and a researcher in the School of Public Health. "At a time when tens of thousands of Americans are waiting for a kidney transplant - and many older patients grow sicker or die before an organ becomes available - the U.S. transplant system may be missing opportunities to save lives."
Next steps could include updating policies to make it easier for transplant centers to use acceptable-quality kidneys, especially for older patients who may be willing to accept a slightly lower-quality organ in exchange for a shorter wait.
The research was supported by a grant from the Agency for Healthcare Research and Quality.
