Temporal changes in deceased kidney donor characteristics in Australia

  • Chan S
  • Campbell S
  • Clayton P
  • et al.
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Abstract

Background: Demand for deceased donor kidneys has exceeded supply in Australia over the past two decades. With a desire to utilise as many donor organs as possible, the health characteristics of accepted donors may have changed over time. Aim: Kidneys from deceased donors in Australia are allocated on waiting time and human leukocyte antigen matching, without consideration of donor kidney quality. It has been observed that the spectrum of deceased donor kidney quality in Australia has become broader over time because of expanding donor age, co-morbidity and mode of donor death. The aim of this study was to describe the temporal changes in Australian donor characteristics between 1994 and 2013. Methods: All deceased kidney donors actually transplanted in Australia between 1 January 1994 and 31 December 2013 were retrospectively analysed, using data from the Australian and New Zealand Organ Donor Registry. Results: Of 4173 deceased donors, 58% were male. Mean donor age increased from 35.4 ± 16.6 years to 46.5 ± 17.5 years over time, and donor numbers increased from 149 in 1994 to 332 in 2013. As the primary cause of death, motor vehicle accidents decreased from 20% to 6% whereas cerebral pathology persisted at 50%. There was an increase in the proportion of donors with hypertension (11.4-23%), diabetes (1-6%) and an increase in mean body mass index (24.4 ± 4.4 to 27.5 ± 6.3 kg/m2) between 1994 and 2013. These changes were reflected by an increase in the median kidney donor risk index from 0.98 ± 0.29 to 1.24 ± 0.42 (P < 0.001). Conclusions: As deceased kidney donor numbers have increased, the range of donor quality has broadened, with an increase in both the proportion and number of high-risk donors, as well as a decline in donor quality. This highlights the need for kidney allocation algorithms to evolve to ensure appropriate allocation of deceased donor kidneys.

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Chan, S., Campbell, S., Clayton, P., Mudge, D., Hawley, C., Johnson, D., & Francis, F. (2017). Temporal changes in deceased kidney donor characteristics in Australia. Internal Medicine Journal, 47, 7–7. https://doi.org/10.1111/imj.2_13457

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