Study Details Rising Trends in Deceased Kidney Donation Differing by Age, Ethnicity

Although recent organ donation trends point to poor rates of deceased kidney transplantation, findings from a recent study suggest this may be partially due to the use of all deaths or traumatic deaths when calculating donors per deaths, thus inflating the number of deaths deemed compatible with deceased donation.¹

The study, published in JAMA Network Open, investigates this trend using the recent Centers for Medicare & Medicaid Services (CMS) final rule redefinition of deaths compatible with donation and shows an overall increase in the proportions of kidney donations from potential donors between 2003 and 2021, contrary to other published metrics.¹

According to the Organ Procurement and Transplantation Network (OPTN), more than 100,000 people are on the national transplant waitlist, the vast majority of whom are seeking a new kidney. In 2023, an all-time volume record was set for kidney transplants, the majority of which were from a living donor. Though the OPTN reported more than 16,000 deceased organ donors in 2023, less is understood about the true rate of deceased donor kidney transplantation.^2,3

“Although 90% of Americans support organ donation, fewer than 10 donors per 1000 deaths were reported in 2020, with this rate unchanging over time,” Jennifer Bragg-Gresham, PhD, associate research scientist in the department of nephrology at University of Michigan, and colleagues wrote.¹ “This trend may be due to using all deaths or traumatic deaths in the metric’s denominator.”

To examine donor trends with a more specific denominator, investigators cross-sectionally combined data from the Scientific Registry of Transplant Recipients and the Centers for Disease Control and Prevention’s Multiple Cause of Death database. They estimated donation rates using the CMS’s final rule, defining potential donors as those < 76 years of age who died in an inpatient setting with a cause of death compatible with donation between January 1, 2003, and December 31, 2021.¹

Results showed the number of potential donors increased from 160,119 in 2003 to 183,211 in 2021, and kidney donations increased from 8654 to 18,691 during this same time frame. Overall, kidney donation rates increased from 54 to 102 per 1000 potential donors, peaking in 2019 at 113 per 1000 with a slight decline shortly thereafter during the 2020 - 2021 COVID-19 pandemic period.¹

Investigators noted large differences in donation by age, with the greatest rates observed among younger ages (<18 - 39 years, 500 per 1000 potential donors). Although no differences were observed by sex, race and ethnicity differed significantly. Deceased donation rates were highest among Hispanic donors, peaking at 150 per 1000 potential donors, and lowest for Asian and Black donors, peaking at 72 and 81 per 1000 potential donors, respectively.¹

Similarly, investigators pointed out large geographic differences, noting the highest rates in Delaware (>200 per 1000) and lowest in the Southeast and Pacific Coast (≤50 per 1000).¹

“While rising trends in deceased kidney donations are encouraging, they are barely more than 1 in 10. The kidney transplant community should partner with patient advocates, community-based organizations, policy makers, and other sectors to increase public education and awareness about the importance of kidney donation,” investigators concluded.¹

References:

1. ^{Bragg-Gresham J, Licon AL, Kiryakos J, Saran R, Roberts JP. Rate of Deceased Kidney Donation From Potential In-Hospital Deaths in the US, 2003-2021. JAMA Netw Open. 2024;7(3):e241865. doi:10.1001/jamanetworkopen.2024.1865}
2. ^{Health Resources & Services Administration. Organ Donation Statistics. February 2024. Accessed March 19, 2024. https://www.organdonor.gov/learn/organ-donation-statistics}
3. ^{Organ Procurement and Transplantation Network. Continued increase in organ donation drives new records in 2023; New milestones exceeded. Newsroom. January 10, 2024. Accessed March 19, 2024. https://optn.transplant.hrsa.gov/news/continued-increase-in-organ-donation-drives-new-records-in-2023-new-milestones-exceeded/}