Abstract
INTRODUCTION: In the United States (US), disparities in access to kidney transplantation exist for waitlisted candidates with end-stage kidney disease. Meanwhile, changes in kidney allocation policy have been associated with a dramatic increase in the number of organ offers declined before an organ is successfully placed. METHODS: We describe transplant and mortality rates for waitlisted candidates from 2015 to 2022 following these allocation changes. RESULTS: Among 249,145 incident waitlisted adults, 180,039 received at least 1 offer and were included in the study. Of these, 37.7% received a deceased donor kidney allograft, 14.7% received a living donor allograft, 7.4% died while on the waiting list, 12.7% were removed, and 27.5% were still waitlisted by the study end period. Overall, candidates' median number of days to receiving their first offer declined from 20 (7-48) in 2015 to 5 (2-13) in 2022. Candidates who died while on the waiting list received a median of 25 (9-56) offers and candidates who were removed received a median of 22 (8-53) offers during the study period. The total number of offers generated by the match-run algorithm, including those from nonutilized kidneys, increased sharply from 7,911,688 offers in 2015 to 13,682,914 in 2019, and to 29,332,516 in 2022. CONCLUSION: These findings emphasize the inefficiencies inherent in our current allocation algorithms and the need to rethink how waitlisted patients are prioritized for a given deceased donor organ in order to maximize the probability of appropriate utilization of lifesaving organs .