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Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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Abstract titles should be brief and reflect the content of the abstract.
The deceased donor kidney discard rate in the United States increased from around 18-20% in 2000s to 25-28% by 2022-2023. On 10/31/2024, revised Kidney Donor Profile Index (KDPI) was introduced, which excluded two factors: Black race, and donor hepatitis C (HCV) status, to improve equity in organ allocation and reflect modern clinical evidence better. The policy change aimed to increase equity (so that donor kidneys are judged by biologic and clinical factors rather than proxies for race) and reduce non-use of otherwise viable kidneys. We examined the temporal trends in discard of deceased donor kidneys, including discard rate, discard reasons and risk factors for discard, following KDPI revision.
We analyze deceased donor kidneys recovered for transplantation from April 2024-April 2025, using the United Network for Organ Sharing database. The study period was divided into two phases, Period 1 (4/1/2024–10/30/2024) and Period 2 (10/31/2024–4/30/2025), to examine temporal changes in donor discard patterns. We investigated the risk factors associated with kidney discard in each period using a multivariable logistic regression model.
During the study period, we identified 32,547 deceased donor kidneys procured from 16,364 donors, of which 9,680 (29.7%) kidneys were discarded. (Fig.1) There was no significant change in the discard rate between Period 1 and Period 2 (p=0.632). The discard rate of Black donors did not change between the two periods (p=0.364), nor did that of HCV-positive donors (p=0.726). The rate of procured organs with KDPI >85% increased from 16.9% in Period 1 to 19.5% in Period 2 (p<0.001), and the rate of kidney biopsy also increased (p<0.001, Table 1). The most common reason for discard in both periods was “no recipient location”, followed by “biopsy findings”.The multivariable logistic regression model demonstrated that in Period 1, HCV-positive donor status was a risk factor for discard (p=0.043), whereas it was no longer a risk factor in Period 2 (p=0.626). Black donor status was not associated with discard in either period. (Table2)
In the short term, KDPI policy change did not have an effect on discard rates, consistent with predictive models that show minimal or modest reductions in discard. While HCV activity was no longer a discard risk factor after policy change, a high KDPI score, and donor medical history remained strong predictors. A longer observation period is required to fully assess the policy’s impact on discard rate and/ or any unintended consequences.
