Kidney donation and transplantation in Eurotransplant 2006-2007: minimizing discard rates by using a rescue allocation policy.

Context: All organ exchange organizations are challenged to maximize the utilization rate of all donors.
Objective: To investigate the benefit of a rescue allocation policy and to study the impact of donor factors on the risk of kidney discard.
Design and Setting: All 4057 donors with kidneys offered for allocation to Eurotransplant between 2006 and 2007 were included. Allocation was patient-oriented, based on a point-score system including recipient and donor factors. If an organ offer was rejected 5 times for medical reasons, allocation was switched to rescue allocation (ie, the organ was then offered in a center-oriented way). A logistic regression model was built to test whether donor factors were predictors of rescue allocation or kidney discard.
Results: Rescue allocation was used for 665 donors (16.4%); within this group, transplant rate was 54.3%, resulting in a donor discard rate of 304 donors (7.5% of total study group). The multivariate model showed that rescue allocation was used significantly more for kidneys from child donors and donors with a high creatinine level. Moreover, testing positive for hepatitis B surface antigen or antibody to hepatitis C virus was associated with an increased probability of rescue allocation. Kidney discard was significantly associated with donation after cardiac death, donor age, serum creatinine level, history of diabetes, and history of hepatitis.
Conclusions: Rescue allocation is effective in lowering donor discard rates. Even with rescue allocation, several donor factors were significantly associated with a higher discard rate. Use of liberal donor criteria and a rescue allocation policy can reduce kidney discards and thus shorten the waiting list for kidney transplantation.