Kidney utilization in the Netherlands – do we optimally use our donor organs?

This article focuses on kidney utilization and discard during the entire deceased donor donation process in the Netherlands from 2015 to 2020. It reveals that the traditional definition of kidney discard—organs procured but not transplanted—underestimates actual non-utilization, which rises from 7.8% to 24.4% when including kidneys not procured despite seeming medically suitable. The main reasons for discard or non-utilization include presumed impaired organ quality (34.2%), with many discarded kidneys affected by mild to moderate acute kidney injury (AKI stages 1 or 2), and donors not dying within the required timeframe after withdrawal of treatment in donation after circulatory death (DCD). The study suggests that revising criteria such as maximum agonal time, improving acceptance of kidneys from donors with AKI, and establishing a prospective registry of discard reasons could enhance kidney utilization.