Since 2021, the Organ Procurement and Transplantation Network has reported a nearly 10-fold rise in out-of-sequence (OOS) kidney allocation, generating concern and halting development of continuous distribution policies. We report contemporary (2022-2023) practice patterns in OOS allocation using Organ Procurement and Transplantation Network data. We examined in sequence vs OOS donors with multivariable logistic regression and skipped vs OOS-accepting recipients with conditional logistic regression. Nearly 20% of kidney placements were OOS, varying from 0% to 43% acsoss organ procurement organizations; the 5 highest OOS-organ procurement organizations accounted for 29% of all OOS. Of OOS kidneys, 33% were declined ≥100 times in the standard allocation sequence and 51% were declined by ≥10 centers before OOS allocation began; 4.5% were made without any in-sequence declines. Nearly, all OOS offers were open offers. OOS kidneys were more likely to be from female, Black, older, donation after cardiac death, hypertensive, diabetic, and elevated creatinine donors. Candidates receiving OOS kidneys were more likely female, Asian, and older than skipped candidates. Higher-volume centers and centers with more White, fewer Hispanic, and more educated waiting list patients underwent transplantation disproportionately with more OOS kidneys. These findings suggest that the current, highly variable, discretionary use of OOS might exacerbate disparities, yet the impact of OOS on organ utilization cannot be determined with data now collected.

中文翻译：

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当代肾脏无序分配的流行率和实践模式


自 2021 年以来，器官采购和移植网络报告称，无序 (OOS) 肾脏分配增加了近 10 倍，引起了人们的关注并停止了连续分配政策的制定。我们使用器官采购和移植网络数据报告当代（2022-2023）OOS分配的实践模式。我们使用多变量逻辑回归按顺序检查了 OOS 捐赠者，并使用条件逻辑回归跳过了 OOS 接受者。近 20% 的肾脏移植是 OOS，在器官获取组织中比例从 0% 到 43% 不等； OOS最高的5个器官采购组织占所有OOS的29%。在 OOS 肾脏中，33% 在标准分配序列中下降 ≥100 次，51% 在 OOS 分配开始前下降 ≥10 个中心； 4.5% 的涨幅没有任何连续下降。几乎所有 OOS 报价都是公开报价。 OOS 肾脏更有可能来自女性、黑人、老年人、心源性死亡后捐献、高血压、糖尿病和肌酐升高的捐献者。与跳过的候选人相比，接受 OOS 肾脏的候选人更有可能是女性、亚洲人且年龄更大。治疗量较大的中心以及等待名单上白人较多、西班牙裔较少、受教育程度较高患者的中心接受移植的 OOS 肾脏较多。这些发现表明，目前 OOS 的高度可变、随意使用可能会加剧差异，但目前收集的数据无法确定 OOS 对器官利用的影响。