Characteristics of a High Functioning Opt-in Deceased Donor Kidney Transplant System

Rationale & Objective A high level of co-operation between organ procurement organizations and transplant programs may help maximize use of deceased donor kidneys. The practices that are essential for a high functioning organ donation and transplant system remain uncertain. We sought to report metrics of organ donation and transplant performance in British Columbia, Canada and assess the association of specific policies and practices that contribute to system performance. Study Design Retrospective observational study. Setting & Participants Referred deceased organ donors in British Columbia between 2016-2019. Exposures Provincial, organ procurement organization and center level policies implemented to improve donor referral and organ utilization. Outcomes. Assessment of donor and kidney utilization along steps the critical pathway for organ donation. Analytical Approach. Deceased donors were classified according to the critical pathway for organ donation and key donation and transplant metrics were identified. Results There were 1948 possible donors referred. Of 1948, 754 (39%) were potential donors. Of 754 potential donors, 587 (78%) were consented donors. Of 587 consented donors, 480 (82%) were eligible kidney donors. Of 480 eligible kidney donors, 438 (91%) were actual kidney donors and of 438 actual kidney donors, 432 (99%) were utilized kidney donors. One-year all-cause allograft survival was 95%. Practices implemented to improve system performance included hospital donor co-ordinators, early communication between the organ procurement organization and transplant nephrologists, dedicated organ recovery and implant surgeons, aged based kidney allocation, and hospital admission of recipients prior to kidney recovery. Limitations Assignment of causality between individual policies and practices and organ donation and utilization is limited in this observational study. Conclusions In British Columbia, consent for donation, utilization of donated kidneys, and transplant survival is exceptionally high, suggesting the importance of an integrated deceased donor and kidney transplant service.