# Rescuing Kidneys at Risk of Discard

> **NIH NIH R01** · NORTHWESTERN UNIVERSITY · 2021 · $697,221

## Abstract

Project Summary. Kidney transplantation (KT) is a superior alternative to dialysis for many patients with
respect to longevity, quality of life, morbidity, and the cost of End-Stage Renal Disease (ESRD) care. However,
of the 95,000 patients waitlisted for a KT in 2017, less than 20,000 received a KT. In the same year, about
4,000 patients died, while another 4,700 were removed from the waitlist because they were considered too sick
to transplant. Despite the long waitlist, more than 3,500 (19%) of the deceased donor kidneys were discarded.
“No Recipient Found” was the stated reason for discarding 1,325 of the donated kidneys. The discard rate
increases significantly for the low-quality kidneys, reaching as high as 60% for the kidneys in the lowest quality
decile. This discard occurs even though many discarded kidneys, even those in the lowest quality decile, would
have conferred significant survival benefits to some recipients relative to remaining on dialysis.
 The current kidney allocation system does not efficiently allocate kidneys at high risk of discard. The
patient prioritization algorithm does not quickly identify patients who will benefit most from such kidneys, and
the donated kidneys are wasted. Improvements to the kidney allocation system are needed to reduce the
number of discarded kidneys while allocating them equitably to patients who would most benefit. However,
revising allocation policy is challenging because patients and transplant professionals must weigh the risks and
benefits of accepting a low-quality kidney against the risks of waiting for a much higher quality kidney. The
transplant community and patient preferences in accepting low-quality kidneys are unknown.
 The proposed study aims to develop kidney allocation algorithms that rescue viable deceased
donor kidneys from discard. The developed algorithms will (i) identify kidneys at risk of discard using
measures such as Kidney Donor Profile Index, or a novel Kidney Discard Risk Score; (ii) identify patient
populations, such as those with longer waiting times to transplant or low functional status, who will benefit the
most from viable kidneys. Preferences of the transplant clinicians (Surgeons and Nephrologists) and patients
(on dialysis and transplant recipients) will be elicited using discrete-choice experiments that will quantify
allocation efficiency and fairness tradeoffs for kidneys at risk of discard. A discrete event simulation software
engine will be developed. The simulation engine will incorporate transplant center and patient-specific kidney
acceptance behaviors, and the developed allocation algorithms. The benefits of different allocation algorithms
will be evaluated in the simulation.
 Representatives from the United Network of Organ Sharing, Association of Organ Procurement
Organizations, and the American Association of Kidney Patients will serve on the scientific advisory board. The
developed allocation algorithms will help save approximately 1,000 lives ...

## Key facts

- **NIH application ID:** 10127632
- **Project number:** 5R01DK118425-03
- **Recipient organization:** NORTHWESTERN UNIVERSITY
- **Principal Investigator:** Sanjay Mehrotra
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $697,221
- **Award type:** 5
- **Project period:** 2019-04-01 → 2023-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10127632

## Citation

> US National Institutes of Health, RePORTER application 10127632, Rescuing Kidneys at Risk of Discard (5R01DK118425-03). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10127632. Licensed CC0.

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