Evaluating non-utilization of deceased donor kidneys in Korea

Considering the low deceased donation rates despite increasing rates of end-stage kidney disease in Asia, minimizing donor kidney discard is important. This study aimed to investigate the current situation of donor kidney discard in Korea. This nationwide study included deceased donor kidneys of candidates for kidney transplantation (KT) between 2013 and 2018 in Korea. Kidney discard was defined as no procurement or discarding after procurement of kidneys. Among 5592 deceased donor kidneys, no-procurement, single-procurement, and double-procurement were 385, 63, and 5144, respectively. All unilaterally procured kidneys, except for one, were transplanted. Bilaterally procured kidneys were accompanied by two KT (n = 5058), one KT with the other kidney discarded (n = 33), or both kidneys discarded (n = 20). The overall kidney discard rate was 7.9%. The cause of non-procurement was universally organ damage, and the common causes of kidney discard after procurement were organ damage, absence of available candidates, and malignancy. While the kidney donor profile index was higher in the discarded group than in the KT group, a large overlap was observed. The risk factors for kidney non-utilization were old age, hypertension, diabetes mellitus, high serum creatinine levels, low hemoglobin levels, and non-cerebrovascular causes of death. KT using contralateral kidney in the discard group showed graft failure and mortality rates comparable to those of KT in the no-discard group. The discard rate of deceased donor kidneys was low, and the discard of one kidney does not necessarily rule out the utilization of contralateral kidney, especially in Korea with a long waiting time.