{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T03:15:29Z","timestamp":1791861329006,"version":"4.3.4"},"reference-count":48,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,11,23]],"date-time":"2022-11-23T00:00:00Z","timestamp":1669161600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Changes in kidney allocation coupled with the COVID\u201019 pandemic have placed tremendous strain on current systems of organ distribution and logistics. Although the number of deceased donors continues to rise annually in the United States, the proportion of marginal deceased donors (MDDs) is disproportionately growing. Cold ischemia times and kidney discard rates are rising in part related to inadequate planning, resources, and shortages. Complexity in kidney allocation and distribution has contributed to this dilemma. Logistical issues and the ability to reperfuse the kidney within acceptable time constraints increasingly determine clinical decision\u2010making for organ acceptance. We have a good understanding of the phenotype of \u201chard to place\u201d MDD kidneys, yet continue to promote a \u201cone size fits all\u201d approach to organ allocation. Allocation and transportation systems need to be agile, mobile, and flexible in order to accommodate the expanding numbers of MDD organs. By identifying \u201chard to place\u201d MDD kidneys early and implementing a \u201cfast\u2010track\u201d or open offer policy to expedite placement, the utilization rate of MDDs would improve dramatically. Organ allocation and distribution based on location, motivation, and innovation must lead the way. In the absence of change, we are sacrificing utility for futility and discard rates will continue to escalate.<\/jats:p>","DOI":"10.1111\/ctr.14847","type":"journal-article","created":{"date-parts":[[2022,11,2]],"date-time":"2022-11-02T11:28:37Z","timestamp":1667388517000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Kidney utility and futility"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7634-094X","authenticated-orcid":false,"given":"Robert J.","family":"Stratta","sequence":"first","affiliation":[{"name":"Department of Surgery Atrium Health Wake Forest Baptist  Winston\u2010Salem North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,11,23]]},"reference":[{"key":"e_1_2_4_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-200211150-00014"},{"key":"e_1_2_4_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/tri.13743"},{"key":"e_1_2_4_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2005.09.032"},{"key":"e_1_2_4_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2019.12.031"},{"key":"e_1_2_4_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2020.12.005"},{"key":"e_1_2_4_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.12034"},{"key":"e_1_2_4_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2014.304"},{"key":"e_1_2_4_9_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2020040464"},{"key":"e_1_2_4_10_1","unstructured":"HonorBridge personal communication August2022."},{"key":"e_1_2_4_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000004127"},{"key":"e_1_2_4_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.13419"},{"key":"e_1_2_4_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16920"},{"key":"e_1_2_4_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16976"},{"key":"e_1_2_4_15_1","unstructured":"Organ Procurement and Transplantation Network (OPTN) Data 2022. 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