Reasons why kidneys removed for transplantation are not transplanted in the United States.

The Organ Center establishes by the South-Eastern Organ Procurement Foundation collected information on 575 kidneys procured but not transplanted in the United States. The greatest proportion, 393, were not transplanted because a crossmatch-negative recipient was not found. Of these kidneys, 260 were transported to at least one additional center and 115 were offered to an additional center within 24 hr of removal. In 18 instances, attempts to share kidneys were made too late. The blood group representation of these kidneys was 62% A, 15% B, 12% AB, 11% O. The SEOPF system of crossmatches enabling the donor center to perform crossmatches on immunized recipients from 42 other transplant centers still resulted in the loss of 98 kidneys. However, this loss was half that predicted from the national experience. Rather than discarding them, 272 kidneys were transported overseas where 183 were transplanted. Technical problems related to the deceased, organ size, anatomic abnormalities, expended or nonviable material for tissue typing, and perfusion failure led to discarding 182 kidneys. Only 15 kidneys were reported injured irremediably at the time of removal, while 12 had bacterial contamination. The data emphasize our national problem and demand collaboration and new systems for kidney distribution in recipients of non-O blood groups.

Duke Scholars

Author Ralph Randal Bollinger Surgery