Optimizing Utilization of Deceased Donor Kidneys Forum

Background 

Despite existing interprovincial organ sharing policies and local allocation practices, programs often find themselves with an organ that cannot be allocated to their provincial lists.  In general, programs will offer organs first to a national program, followed by their local transplant waitlist. Once both of these avenues have been exhausted, there is a lack of consistency and clear direction on how to allocate these organs to their peer organizations inside the country.  

This project was launched in September 2017 at the Canadian Society of Transplantation (CST) meeting in Halifax, NS. This leading practice engaged members from deceased donation, transplantation, Laboratory (HLA/Histocompatibility), ethics, and ODO administration, with the goal of producing guiding principles, recommendations, and eventually policies to guide the allocation of organs that are difficult to place locally.  Kidneys will be the initial organ of focus with the intention of engaging the heart and liver communities in subsequent phases. 

 Forum Objectives and Process 

Webinars were held October 14 and 15, 2021 to provide attendees with necessary background information to assist in forum discussions. The forum took place virtually on October 21 and 28, 2021, engaging pan-Canadian representatives from ethics, legal, critical care, donation, as well as adult and pediatric transplant programs. 

Objectives of the forum included: 

  • Review current organ utilization and best practice research; review clinical/administrative allocation and assessment practices in Canada/internationally. 

  • Consult with patients, donation/transplantation nephrologists, surgeons, and others. 

  • Build a national consensus on the criteria for tracking hard-to-place kidneys and recipients who accept these. 

  • Develop final consensus recommendations for Canadian listing and allocation policies for hard-to-place kidneys. 

  • Achieve understanding of how the outputs of this meeting align with the broader Interprovincial Organ Sharing Programs strategy of Canadian Blood Services 

Forum attendees participated in both small group and plenary discussions to provide recommendations on the following topics: 

  • Characteristics of donors whose organ are at risk of not being utilized 

  • Donor data required at time of kidney offer 

  • Accountability processes to maximize utilization of these organs 

  • Communication of risk and benefit to recipients 

  • Principles that guide the allocation of these organs 

  • System responsibilities in case of early graft loss 

  • Recipients that are likely to have improved outcomes with these organs versus staying on dialysis 

  • Processes to use to maximize outcomes of these organs 

  • Required post-transplant outcome data 

Forum Report:

Optimizing Utilization of Deceased Donor Kidneys - National forum report October 2021

Related Publications:

Dionne, J.C, Campbell, P., Cardinal, H., Giannidis, T., Goldberg, A., Kim, S.J., Knoll, G., Pâquet, M., Parsons, C., Yuan, Y. & Mainra, R. (2025) Optimizing the use of deceased donor kidneys at risk of discard: A clinical practice guideline. Transplant International, 38. https://doi.org/10.3389/ti.2025.14596 

Vinson, A.J., Cardinal, H., Parsons, C., Tennankore, K.K., Mainra, R., Maru, K., Treleaven, D., & Gill, J. (2023). Disparities in deceased donor kidney offer acceptance: A survey of Canadian transplant nephrologists, general surgeons and urologists. Canadian Journal of Kidney Health and Disease, 10. https://doi.org/10.1177/20543581231156855  

Rosaasen, C., Rosaasen, N., Mainra, R., Trachtenberg, A., Ho, J., Parsons, C., Delaney, S., & Mansell, H. (2022). Waitlisted and transplant patient perspectives on expanding access to deceased-donor kidney transplant: A qualitative study. Canadian Journal of Kidney Health and Disease, 9. https://doi.org/10.1177/20543581221100291  

Kadatz, M.J., Gill, J., Gill, J., Lan, J.H., McMichael, L.C., Chang, D.T., & Gill, J.S. (2023). The benefits of preemptive transplantation using high–Kidney Donor Profile Index kidneys. Clinical Journal of the American Society of Nephrology, 18(5), 634–643. https://doi.org/10.2215/CJN.0000000000000134  

Trachtenberg, A., Shenoy, V., Dodd, N., Hager, D., Karpinski, M., Koulack, J., Maxwell, K., Mazurat, A., Pochinco, D., Sathianathan, C., Shaw, J., Wiebe, C., Nickerson, P., & Ho, J. (2024). Program report: Expanding the deceased donor pool in Manitoba with an age-targeted kidney transplant program. Canadian Journal of Kidney Health and Disease, 11. https://doi.org/10.1177/20543581241287288  

For Additional Information please contact otdt@blood.ca.