Association Between Declined Offers of Deceased Donor Kidney Allograft and Outcomes in Kidney Transplant Candidates

Key Points Question What are the outcomes for wait-listed kidney transplant candidates after a transplant center’s refusal to accept a deceased donor kidney offer on their behalf? Findings In this cohort study of 280 041 wait-listed kidney transplant candidates who received at least 1 deceased donor kidney offer, approximately 30% of these candidates eventually died or were removed from the waiting list before receiving an allograft. Deceased donor kidney allograft recipients received a median of 17 offers over 422 days, whereas candidates who died while waiting received a median of 16 offers over 651 days, and the odds of death on the waiting list after receiving an offer varied across the United States. Meaning This study suggests that a large number of deceased donor kidney offers are received by candidates but are declined on their behalf, resulting in what appears to be many missed opportunities for a transplant before death or removal from the waiting list.