Center-level patterns of indicated willingness to and actual acceptance of marginal kidneys

A. B. Massie, D. E. Stewart, N. N. Dagher, R. A. Montgomery, N. M. Desai, D. L. Segev

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


UNetSM, the UNOS data collection and electronic organ allocation system, allows centers to specify organ offer acceptance criteria for patients on their kidney waiting list. We hypothesized that the system might not be fully utilized and that the criteria specified by most transplant centers would be much broader than the characteristics of organs actually transplanted by those centers. We analyzed the distribution of criteria values among waitlist patients (N = 304 385) between January 2000 and February 2009, mean criteria values among listed candidates on February 19, 2009 and differences between a center's specified criteria and the organs it accepted for transplant between July 2005 and April 2009. We found wide variation in use of criteria variables, with some variables mostly or entirely unused. Most centers specified very broad criteria, with little within-center variation by patient. An offer of a kidney with parameters more extreme than the maximum actually transplanted at that center was designated a surplus offer and indicated a potentially avoidable delay in distribution. We found 7373 surplus offers (7.1% of all offers), concentrated among a small number of centers. The organ acceptance criteria system is currently underutilized, leading to possibly avoidable inefficiencies in organ distribution.

Original languageEnglish (US)
Pages (from-to)2472-2480
Number of pages9
JournalAmerican Journal of Transplantation
Issue number11
StatePublished - Nov 2010


  • Deceased donor transplantation
  • donor criteria
  • organ allocation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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