{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T03:47:52Z","timestamp":1789098472811,"version":"build-2803163510"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","funder":[{"DOI":"10.13039\/100001259","name":"National Kidney Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001259","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["R01 DK114893"],"award-info":[{"award-number":["R01 DK114893"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["U01 DK116066"],"award-info":[{"award-number":["U01 DK116066"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009827","name":"Laura and John Arnold Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009827","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000102","name":"Health Resources and Services Administration","doi-asserted-by":"publisher","award":["234-2005-37011C"],"award-info":[{"award-number":["234-2005-37011C"]}],"id":[{"id":"10.13039\/100000102","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>An increasing number of patients on the waitlist for a kidney transplant indicates a need to effectively utilize as many deceased donor kidneys as possible while ensuring acceptable outcomes. Assessing regional and center-level organ utilization with regards to discard can reveal regional variation in suboptimal deceased donor kidney acceptance patterns stemming from perceptions of risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting, participants, &amp; measurements<\/jats:title>\n                    <jats:p>We created a weighted donor utilization index from a logistic regression model using high-risk donor characteristics and discard rates from 113,640 deceased donor kidneys procured for transplant from 2010 to 2016, and used it to examine deceased donor kidney utilization in 182 adult transplant centers with &gt;15 annual deceased donor kidney transplants. Linear regression and correlation were used to analyze differences in donor utilization indexes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The donor utilization index was found to significantly vary by Organ Procurement and Transplantation Network region (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001), revealing geographic trends in kidney utilization. When investigating reasons for this disparity, there was no significant correlation between center volume and donor utilization index, but the percentage of deceased donor kidneys imported from other regions was significantly associated with donor utilization for all centers (rho=0.39;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). This correlation was found to be particularly strong for region 4 (rho=0.83;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.001) and region 9 (rho=0.82;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.001). Additionally, 25th percentile time to transplant was weakly associated with the donor utilization index (\n                      <jats:italic toggle=\"yes\">R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      =0.15;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.03).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There is marked center-level variation in the use of deceased donor kidneys with less desirable characteristics both within and between regions. Broader utilization was significantly associated with shorter time to transplantation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.02770319","type":"journal-article","created":{"date-parts":[[2019,10,17]],"date-time":"2019-10-17T15:55:18Z","timestamp":1571327718000},"page":"1634-1641","source":"Crossref","is-referenced-by-count":52,"title":["A Donor Utilization Index to Assess the Utilization and Discard of Deceased Donor Kidneys Perceived as High Risk"],"prefix":"10.2215","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0101-2754","authenticated-orcid":false,"given":"Corey","family":"Brennan","sequence":"first","affiliation":[{"name":"The Columbia University Renal Epidemiology (CURE) Group, New York, New York;"},{"name":"Department of Transplant Surgery, New York\u2013Presbyterian Hospital, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1823-0117","authenticated-orcid":false,"given":"Syed Ali","family":"Husain","sequence":"additional","affiliation":[{"name":"The Columbia University Renal Epidemiology (CURE) Group, New York, New York;"},{"name":"Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7920-7615","authenticated-orcid":false,"given":"Kristen L.","family":"King","sequence":"additional","affiliation":[{"name":"The Columbia University Renal Epidemiology (CURE) Group, New York, New York;"},{"name":"Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6428-5525","authenticated-orcid":false,"given":"Demetra","family":"Tsapepas","sequence":"additional","affiliation":[{"name":"The Columbia University Renal Epidemiology (CURE) Group, New York, New York;"},{"name":"Department of Transplant Surgery, New York\u2013Presbyterian Hospital, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lloyd E.","family":"Ratner","sequence":"additional","affiliation":[{"name":"Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhezhen","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse D.","family":"Schold","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences and"},{"name":"Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5305-9685","authenticated-orcid":false,"given":"Sumit","family":"Mohan","sequence":"additional","affiliation":[{"name":"The Columbia University Renal Epidemiology (CURE) Group, New York, New York;"},{"name":"Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York;"},{"name":"Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,10,17]]},"reference":[{"key":"B2-20230813","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.kint.2018.02.016","article-title":"Factors leading to the discard of deceased donor kidneys in the United 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transplantation.","volume":"101","author":"Heilman","year":"2017","journal-title":"Transplantation"},{"key":"B7-20230813","doi-asserted-by":"crossref","first-page":"1404","DOI":"10.1111\/j.1600-6143.2007.01784.x","article-title":"Developing organ offer and acceptance measures: When \u2018good\u2019 organs are turned down.","volume":"7","author":"Wolfe","year":"2007","journal-title":"Am J Transplant"},{"key":"B9-20230813","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1097\/TP.0000000000000446","article-title":"Changes in geographic disparity in kidney transplantation since the final rule.","volume":"98","author":"Davis","year":"2014","journal-title":"Transplantation"},{"key":"B10-20230813","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1001\/jamacardio.2015.0248","article-title":"Moving from disease-centered to patient goals-directed care for patients with multiple chronic conditions: Patient value-based 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Transplant"},{"key":"B32-20230813","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1111\/ctr.12582","article-title":"Changing the paradigm of organ utilization from PHS increased-risk donors: An opportunity whose time has come?","volume":"29","author":"Sibulesky","year":"2015","journal-title":"Clin Transplant"},{"key":"B33-20230813","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1097\/TP.0b013e318243c6e4","article-title":"Recipient and donor body mass index as important risk factors for delayed kidney graft function.","volume":"93","author":"Weissenbacher","year":"2012","journal-title":"Transplantation"},{"key":"B34-20230813","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1111\/ajt.12643","article-title":"Impact of HLA mismatch at first kidney transplant on lifetime with graft function in young recipients.","volume":"14","author":"Foster","year":"2014","journal-title":"Am J 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