ArticleAmerican journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons2025
Contemporary prevalence and practice patterns of out-of-sequence kidney allocation.
Article in American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
What it found
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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.
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Who cites it
19 citing papers in PubMed.
- Characterizing Within-Center Placement of Out-of-Sequence Deceased-Donor Kidney Transplants.Kidney international reports · 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
- Impact of Cold Ischemia Time on Allograft Survival and Policy.Kidney international reports · 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
- Machine Learning Predictions for Assessing Hard-to-Place Deceased Donor Kidneys.Kidney medicine · 2026Article
- 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
- Changes in Deceased Donor Kidney Recovery and Transplantation after Increased Regulatory Oversight of Allocation Out of Sequence.Journal of the American Society of Nephrology : JASN · 2026Article
- Lung transplantation from donation after circulatory death donors over 55 years old: A national analysis of outcomes and utilization.JHLT open · 2026Article
- The impact of simultaneous batch turn downs and targeted kidney utilization decisions on patient survival.PloS one · 2026Article
- 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 early impacts of an attempt to standardize kidney procurement biopsy practices.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2025Article
- Article
- 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
- 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
- Adopting orphan deceased donor kidneys for transplantation.BMC nephrology · 2025Article
- Optimizing kidney allocation: challenges and solutions.Current opinion in organ transplantation · 2025Review
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
Since 2021, the Organ Procurement and Transplantation Network has reported a nearly 10-fold rise in out-of-sequence (OOS) kidney allocation, generating concern and halting development of continuous distribution policies. We report contemporary (2022-2023) practice patterns in OOS allocation using Organ Procurement and Transplantation Network data. We examined in sequence vs OOS donors with multivariable logistic regression and skipped vs OOS-accepting recipients with conditional logistic regression. Nearly 20% of kidney placements were OOS, varying from 0% to 43% acsoss organ procurement organizations; the 5 highest OOS-organ procurement organizations accounted for 29% of all OOS. Of OOS kidneys, 33% were declined ≥100 times in the standard allocation sequence and 51% were declined by ≥10 centers before OOS allocation began; 4.5% were made without any in-sequence declines. Nearly, all OOS offers were open offers. OOS kidneys were more likely to be from female, Black, older, donation after cardiac death, hypertensive, diabetic, and elevated creatinine donors. Candidates receiving OOS kidneys were more likely female, Asian, and older than skipped candidates. Higher-volume centers and centers with more White, fewer Hispanic, and more educated waiting list patients underwent transplantation disproportionately with more OOS kidneys. These findings suggest that the current, highly variable, discretionary use of OOS might exacerbate disparities, yet the impact of OOS on organ utilization cannot be determined with data now collected.
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