Supported Research

Lay Abstract

Kidney transplant is the treatment of choice for patients with kidney failure. Kidneys may come from living or deceased donors. After a potential suitable deceased donor kidney is identified, the kidney is matched to potential recipient candidates in a process called ‘allocation’. The kidney transplant offer is then accepted or declined by the physician on call for kidney transplant at the transplant center of an allocated recipient. Kidneys from deceased donors are utilized and allocated to transplant recipient candidates in a non-standardized approach across transplant centres. Given limited availability of deceased donor organs, and significance of these decisions on potential recipients, there is a need to audit and critically review decision-making and allocation of kidney offers. I will describe characteristics of deceased donor kidneys that have been discarded in Ontario, including measures of organ quality, recipient characteristics, matching of donors to recipients, logistics of organ procurement, characteristics of individual transplant centers and physicians, and influence of prior decisions. I will explore the impact of these factors on decisions to utilize or discard deceased donor kidney offers. I will link these characteristics to outcomes in cases where only versus both kidneys were transplanted, or by matching discarded kidneys to comparable kidneys that were transplanted. I will administer a survey of hypothetical deceased donor kidney offers to all kidney transplant doctors in Canada to assess which factors are utilized in real-world decision making on which kidneys are utilized or discarded. I will use these responses to conduct focus groups with both transplant healthcare providers to discuss these findings in the context of issues specific to various transplant centers. I will also conduct focus groups with patients to explore their perspectives on which factors are and should be utilized in decision-making. Existing kidney allocation algorithms do not incorporate measures of recipient wellness to match donor kidneys to recipients and optimize both kidney graft and patient survival. I will compare the historical kidney allocation sequence that occurred in Ontario to a simulated allocation run with an algorithm incorporating measures of donor kidney and recipient wellness. I will describe whether this allows allocation matches with organs that would’ve historically been discarded. These findings are of interest to kidney transplant candidates, healthcare providers, and are in the interest of deceased donors and their loved ones. These results may increase transparency and accountability in decision-making and allocation algorithms, which can facilitate further research to optimize these strategies.