Non-Retrieval and Non-Utilisation of Deceased Donor Kidneys for Transplantation: An Australian Cohort Study

Rachel B Cutting; Nicole L De La Mata; Animesh Singla; James A Hedley; Helen Opdam; Philip Clayton; Kate Wyburn; Elena Cavazzoni; Paul Robertson; Henry Pleass; Angela C Webster

doi:10.1111/ans.70208

Non-Retrieval and Non-Utilisation of Deceased Donor Kidneys for Transplantation: An Australian Cohort Study

ANZ J Surg. 2025 Jun 5. doi: 10.1111/ans.70208. Online ahead of print.

Authors

Rachel B Cutting¹, Nicole L De La Mata¹, Animesh Singla^{2

3}, James A Hedley¹, Helen Opdam^{4

5}, Philip Clayton^{6

7

8}, Kate Wyburn^{9

10}, Elena Cavazzoni^{11

12}, Paul Robertson¹³, Henry Pleass^{3

14}, Angela C Webster^{1

15

16}

Affiliations

¹ Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia.
² Discipline of Surgery, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
³ Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.
⁴ Organ and Tissue Authority, Australian Government, Canberra, Australian Capital Territory, Australia.
⁵ Intensive Care Unit, Austin Hospital, Heidelberg, Victoria, Australia.
⁶ Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), Royal Adelaide Hospital, Adelaide, Australia.
⁷ Faculty of Health and Medical Science, University of Adelaide, Adelaide, Australia.
⁸ Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia.
⁹ Sydney Medical School, University of Sydney, Camperdown, Australia.
¹⁰ Renal Unit, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, New South Wales, Australia.
¹¹ Department of Paediatric Intensive Care, Children's Hospital Westmead, Westmead, New South Wales, Australia.
¹² Organ and Tissue Donation Service, New South Wales Government, Kogarah, New South Wales, Australia.
¹³ Sydney West Area Health Service, Western Sydney Local Health District, New South Wales Government, Sydney, New South Wales, Australia.
¹⁴ Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia.
¹⁵ National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia.
¹⁶ Westmead Applied Research Centre, Westmead Hospital, Westmead, New South Wales, Australia.

PMID: 40470609
DOI: 10.1111/ans.70208

Abstract

Background: An efficient organ donation programme must maximise transplantation following initiation of organ recovery procedures.

Methods: We conducted a cohort study of deceased donors in Australia (2014-2021) using Australia and New Zealand Organ Donation Registry data to characterise kidney non-retrieval (post-incision) and non-utilisation (retrieved, not transplanted). Donor characteristics included kidney side (left/right), kidney-only procurement, kidney donor profile index (KDPI), cause of death, resuscitation, donation after circulatory/neurological determination of death (DCDD/DNDD) and donor criteria (standard SCD/extended ECD), year, age, sex, blood group, ethnicity, comorbidities, smoking, BMI, weight, remoteness, occupation and socioeconomic disadvantage. System characteristics included jurisdiction of donor hospital, retrieval team and recipient's hospital.

Results: Among 7211 kidneys (3683 donors) accepted for retrieval, 675 (9%) were non-retrieved and 430 (7%) were non-utilised. Crude non-retrieval rates doubled from 5% to 10% between 2014 and 2021 (p = 0.01) while non-utilisation remained around 7% (p = 0.1). After adjustment, non-retrieval was greater among donors with KDPI ≥ 75 (OR: 4.28, 95% CI: 2.08-8.81, p < 0.001), diabetes (OR: 1.74, 95% CI: 1.25-2.43, p = 0.001) and in recent years (annual OR: 1.08, 95% CI: 1.03-1.55, p = 0.002), and lower for ECD DCDD (OR: 0.46, 95% CI: 0.26-0.81, p = 0.01). Non-utilisation was greater for SCD DCDD (OR: 1.90, 95% CI: 1.28-2.82, p < 0.001), blood group AB (OR: 2.05, 95% CI: 1.16-3.64, p = 0.03) and in recent years (annual OR: 1.08, 95% CI: 1.02-1.15, p = 0.01), and lower in Tasmania (OR: 0.28, 95% CI: 0.08-0.97) and Queensland (OR: 0.57, 95% CI: 0.36-0.92, p = 0.03). Documented reasons for non-utilisation lacked transparency but included poor perfusion (17%).

Conclusion: Increasing utilisation of higher KDPI kidneys and enhancing perfusion could help maximise kidney transplantation.

Keywords: kidney failure; kidney transplantation; tissue and organ procurement.

Grants and funding

#1177117/NHMRC Investigator Grant