{"doi":"10.1016/j.ekir.2021.06.002","title":"Deceased Donor Kidneys Utilization and Discard Rates During COVID-19 Pandemic in the United States","abstract":"The COVID-19 pandemic created significant disruptions to kidney transplantation in the United States. Particularly in the initial surge, there was a dramatic decrease in deceased donor transplants, a near complete cessation in living donor kidney transplants, and considerable mortality among kidney transplant candidates.1Goff R.R. Wilk A.R. Toll A.E. McBride M.A. Klassen D.K. Navigating the COVID-19 pandemic: Initial impacts and responses of the Organ Procurement and Transplantation Network in the United States.Am J Transplant. 2020; 21: 2100-2112Crossref PubMed Scopus (37) Google Scholar, 2Boyarsky B.J. Po-Yu Chiang T. Werbel W.A. et al.Early impact of COVID-19 on transplant center practices and policies in the United States.Am J Transplant. 2020; 20: 1809-1818Crossref PubMed Scopus (215) Google Scholar, 3Schold J.D. King K.L. Husain S.A. Poggio E.D. Buccini L.D. Mohan S. COVID-19 mortality among kidney transplant candidates is strongly associated with social determinants of health.Am J Transplant. 2021; 21: 2563-2572Crossref PubMed Scopus (16) Google Scholar Although some of the significant operational challenges for organ procurement organizations and transplant centers have been described,4Friedman A.L. Delli Carpini K.W. Ezzell C. Irving H. There are no best practices in a pandemic: organ donation within the COVID-19 epicenter.Am J Transplant. 2020; 20: 3089-3093Crossref PubMed Scopus (16) Google Scholar remarkably more deceased donor kidney transplants occurred in 2020 than in any previous year. However, the impact of the pandemic on organ procurement and utilization are unclear. In this study, we evaluated the impact of the COVID-19 pandemic on deceased donor kidney utilization and discard rates in the United States in 2020 using national registry data as of January 1, 2021 (Supplementary Methods). The overall number of deceased donors dropped dramatically during the initial COVID-19 surge (March 18–May 12, 2020) from a mean (SD) of 252 (±15) donors weekly presurge to a low of 156 donors the week beginning March 25, 2020 (Supplementary Figure S1). From an already reduced number of deceased donors, 168 kidneys (6%) that were consented for transplantation were not even procured during the initial surge (Table 1). The weekly kidney discard rate among procured kidneys was highest during the initial surge, dropped after the surge, and rose mildly in the summer and again at the end of the year, coinciding with different waves of COVID-19 infections in 2020 instead of following the relatively flat trend as observed in 2019 (Supplementary Figures S1 and S2). During the initial surge, up to 29% of the kidneys recovered weekly for transplantation were discarded. The annual discard rate in 2020 was 21% (5051 kidneys), with regional variation (Supplementary Figure S3). Overall organ disposition varied significantly by Organ Procurement and Transplant Network (OPTN) region both during the initial surge and for all of 2020 (both P < 0.001; Table 1). During the initial surge, the proportion of consented donor kidneys that were not transplanted ranged from a high of 31% discarded and 15% not procured in region 9 to a low of 18% discarded and 2% not procured in region 10.Table 1Deceased donor characteristics by organ dispositions during the initial surge versus all of 2020Donor characteristicsAll of 2020Initial surge: Weeks 12–19Transplanted, n (%)(n = 18,686; 74.8%)Discarded, n (%)(n = 5051; 20.2%)Not procured, n (%)(n = 1250; 5.0%)Transplanted, n (%)(n = 2,165; 72.5%)Discarded, n (%)(n = 654; 21.9%)Not procured, n (%)(n = 168; 5.6%)Age, median (IQR)38 (27–50)56 (45–62)54 (43–64)36 (27–48)54 (40–60)51 (36–63)Gender Female6813 (72)2215 (23)495 (5)794 (69)288 (25)72 (6) Male11,873 (77)2836 (18)755 (5)1371 (75)366 (20)96 (5)Race/ethnicity White12,323 (75)3487 (21)599 (4)1448 (74)437 (22)79 (4) Black2709 (69)806 (21)394 (10)307 (65)111 (24)52 (11) Hispanic2880 (79)561 (15)214 (6)309 (74)84 (20)26 (6) Other774 (76)197 (19)43 (4)101 (75)22 (","journal":"Kidney International Reports","year":2021,"id":165817,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":35,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9555,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":237293,"name":"Kristen L. King","orcid":"0000-0002-7920-7615","position":1,"is_corresponding":false},{"id":128646,"name":"S. Ali Husain","orcid":"0000-0002-1823-0117","position":2,"is_corresponding":false},{"id":353282,"name":"Jesse D. Schold","orcid":"0000-0002-5341-7286","position":3,"is_corresponding":false},{"id":104006,"name":"Sumit Mohan","orcid":"0000-0002-5305-9685","position":4,"is_corresponding":false},{"id":319706,"name":"Miah T. Li","orcid":"0000-0003-4301-3525","position":0,"is_corresponding":true}],"reference_count":6,"raw_metadata":null,"created_at":"2026-07-18T23:45:40.838485Z","pmid":"34514207","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}