ArticleAmerican journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons2022
Deceased donor kidneys allocated out of sequence by organ procurement organizations.
Article in American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
29 citing papers in PubMed.
- Characterizing Within-Center Placement of Out-of-Sequence Deceased-Donor Kidney Transplants.Kidney international reports · 2026Article
- A Sliding Scale AdaptiVe Expedited rescue algorithm for deceased donor kidney transplantation.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2026Article
- Newly Designed Expedited Allocation Pathways Cannot Be Expected to Rely on Data That Do Not Currently Exist.Kidney360 · 2026Article
- Out-of-Sequence Donor Heart Allocation: A United Network for Organ Sharing Registry Analysis.Journal of cardiac failure · 2026Article
- Recipient Selection and Outcomes After Out-of-Sequence Kidney Allocation Since Implementation of Kidney Allocation System 250 (KAS250): A Single-Center Experience.Clinical transplantation · 2026Article
- Evolution of out-of-sequence liver allocation, 2019-2024.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2026Article
- Outcomes of Deceased Donor Kidney Transplants Allocated Out of Sequence in the United States.Clinical journal of the American Society of Nephrology : CJASN · 2026Observational
- Expedited Kidney Offers Are Occurring Earlier During Allocation.Kidney medicine · 2026Article
- Is the Current Practice of Out-of-Sequence Kidney Allocation Justified? Assessing Outcomes, Utility, Efficiency, and Equity.Clinical journal of the American Society of Nephrology : CJASN · 2026Article
- Expedited Transplant Allocation Using a Paired Kidney Cohort.JAMA network open · 2026Article
- T cell-mediated immune responses in xenotransplantation: mechanisms and therapeutic strategies.Frontiers in immunology · 2026Review
- Out-of-Sequence Placement of Deceased Donor Kidneys Is Exacerbating Inequities in the United States.Clinical journal of the American Society of Nephrology : CJASN · 2026Article
- The impact of simultaneous batch turn downs and targeted kidney utilization decisions on patient survival.PloS one · 2026Article
- Acceptance of High Kidney Donor Profile Index Kidneys Among Consented Candidates.Kidney international reports · 2025Article
- Article
- Underrecognition of deceased donor kidney out-of-sequence allocation due to increasing use of free-text coding.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2025Article
- Association between out-of-sequence allocation and deceased donor kidney nonuse across organ procurement organizations.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2025Article
- Decreasing efficiency in deceased donor kidney offer notifications under the new distance-based kidney allocation system.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2025Article
- Patient and Provider Attitudes Toward Patient-Facing Kidney Organ Offer Reporting.Kidney international reports · 2025Article
- Outcomes for Patients With a Deceased Donor Kidney Offer in the New Allocation System.Kidney international reports · 2025Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
Deceased donor kidney allocation follows a ranked match-run of potential recipients. Organ procurement organizations (OPOs) are permitted to deviate from the mandated match-run in exceptional circumstances. Using match-run data for all deceased donor kidney transplants (Ktx) in the US between 2015 and 2019, we identified 1544 kidneys transplanted from 933 donors with an OPO-initiated allocation exception. Most OPOs (55/58) used this process at least once, but 3 OPOs performed 64% of the exceptions and just 2 transplant centers received 25% of allocation exception Ktx. At 2 of 3 outlier OPOs these transplants increased 136% and 141% between 2015 and 2019 compared to only a 35% increase in all Ktx. Allocation exception donors had less favorable characteristics (median KDPI 70, 41% with history of hypertension), but only 29% had KDPI ≥ 85% and the majority did not meet the traditional threshold for marginal kidneys. Allocation exception kidneys went to larger centers with higher offer acceptance ratios and to recipients with 2 fewer priority points-equivalent to 2 less years of waiting time. OPO-initiated exceptions for kidney allocation are growing increasingly frequent and more concentrated at a few outlier centers. Increasing pressure to improve organ utilization risks increasing out-of-sequence allocations, potentially exacerbating disparities in access to transplantation.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.