Expedited Transplant Allocation Using a Paired Kidney Cohort

How frequently does out-of-sequence allocation of a kidney follow in-sequence placement of a kidney from the same donor, and what are the survival outcomes of recipients?In this cohort study of 15 602 kidneys from 8544 deceased donors, unilateral out-of-sequence allocation increased 17-fold, with the first attempt occurring at a median sequence number of 28 in 2024 (vs 393 in 2020). There were no significant differences in patient or graft outcomes between unilateral out-of-sequence and unilateral in-sequence transplants.Restricting analyses to cases in which the allocation system was successful for the contralateral kidney raises questions about how organ procurement organizations decide to perform out-of-sequence allocation, given that neither organ quality nor timing appeared to be associated with this decision.

Corresponding Author: Sumit Mohan, MD, MPH, Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, 622 W 168th St, PH4-124, New York, NY 10032 (sm2206@cumc.columbia.edu).

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