Non-Retrieval and Non-Utilisation of Deceased Donor Kidneys for Transplantation: An Australian Cohort Study

Background: An efficient organ donation programme must maximise transplantation following initiation of organ recovery procedures. Methods: We conducted a cohort study of deceased donors in Australia (2014–2021) using Australia and New Zealand Organ Donation Registry data to characterise kidney non-retrieval (post-incision) and non-utilisation (retrieved, not transplanted). Donor characteristics included kidney side (left/right), kidney-only procurement, kidney donor profile index (KDPI), cause of death, resuscitation, donation after circulatory/neurological determination of death (DCDD/DNDD) and donor criteria (standard SCD/extended ECD), year, age, sex, blood group, ethnicity, comorbidities, smoking, BMI, weight, remoteness, occupation and socioeconomic disadvantage. System characteristics included jurisdiction of donor hospital, retrieval team and recipient's hospital. Results: Among 7211 kidneys (3683 donors) accepted for retrieval, 675 (9%) were non-retrieved and 430 (7%) were non-utilised. Crude non-retrieval rates doubled from 5% to 10% between 2014 and 2021 (p = 0.01) while non-utilisation remained around 7% (p = 0.1). After adjustment, non-retrieval was greater among donors with KDPI ≥ 75 (OR: 4.28, 95% CI: 2.08–8.81, p < 0.001), diabetes (OR: 1.74, 95% CI: 1.25–2.43, p = 0.001) and in recent years (annual OR: 1.08, 95% CI: 1.03–1.55, p = 0.002), and lower for ECD DCDD (OR: 0.46, 95% CI: 0.26–0.81, p = 0.01). Non-utilisation was greater for SCD DCDD (OR: 1.90, 95% CI: 1.28–2.82, p < 0.001), blood group AB (OR: 2.05, 95% CI: 1.16–3.64, p = 0.03) and in recent years (annual OR: 1.08, 95% CI: 1.02–1.15, p = 0.01), and lower in Tasmania (OR: 0.28, 95% CI: 0.08–0.97) and Queensland (OR: 0.57, 95% CI: 0.36–0.92, p = 0.03). Documented reasons for non-utilisation lacked transparency but included poor perfusion (17%). Conclusion: Increasing utilisation of higher KDPI kidneys and enhancing perfusion could help maximise kidney transplantation.