Tucker Emma G, Yu Miko E, Adler Joel T, Cron David C, Sahni Prateek V, Schold Jesse D, Mohan Sumit, Husain Syed Ali
Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York, USA; Columbia University Renal Epidemiology Group, New York, New York, USA.
Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, Texas, USA.
Am J Transplant. 2025 Aug;25(8):1715-1722. doi: 10.1016/j.ajt.2025.04.002. Epub 2025 Apr 9.
Out-of-sequence (OOS) allocation, the process by which organ procurement organizations (OPOs) can deviate from standard rank lists of potential recipients to expeditiously allocate deceased-donor kidneys, is increasing in the United States. We aimed to determine whether current OPO reporting practices obscure the extent of OOS allocation. Using match-run data for all US deceased-donor kidney transplants from 2021-2023, we defined miscoded OOS (mOOS) allocation transplants as those with use of the 799 or 898 OPO-initiated refusal codes (other, specify) with free-text responses clearly indicating OOS allocation and compared them with explicit OOS allocation, in which OOS transplants are appropriately coded using refusal codes 861 to 863. We found that the prevalence of mOOS allocation increased from 2021 (122 transplants) to 2023 (430 transplants) and accounted for 12% of all OOS transplants by 2023. Organs allocated via mOOS had a lower median kidney donor profile index than those allocated via explicit OOS (51% vs 55%, P < .01). While an increasing number of OPOs used mOOS throughout the study period, the practice remained concentrated overall, with 5 high-frequency OPOs performing 66% of mOOS allocations in 2023. These findings highlight the need for stricter oversight of organ allocation and underscore the responsibility of the Organ Procurement and Transplant Network to ensure proper data reporting.
非顺序（OOS）分配是指器官获取组织（OPO）可以偏离潜在受者的标准排名列表以迅速分配 deceased 供体肾脏的过程，在美国这种情况正在增加。我们旨在确定当前 OPO 的报告做法是否掩盖了 OOS 分配的程度。利用 2021 年至 2023 年美国所有 deceased 供体肾脏移植的匹配运行数据，我们将错误编码的 OOS（mOOS）分配移植定义为那些使用 799 或 898 OPO 发起的拒绝代码（其他，具体说明）且自由文本回复明确表明 OOS 分配的移植，并将它们与明确的 OOS 分配进行比较，在明确的 OOS 分配中，OOS 移植使用拒绝代码 861 至 863 进行适当编码。我们发现，mOOS 分配的发生率从 2021 年（122 例移植）增加到 2023 年（430 例移植），到 2023 年占所有 OOS 移植的 12%。通过 mOOS 分配的器官的肾脏供体概况指数中位数低于通过明确的 OOS 分配的器官（51%对 55%，P <.01）。虽然在整个研究期间越来越多的 OPO 使用 mOOS，但这种做法总体上仍然集中，2023 年 5 个高频 OPO 进行了 66%的 mOOS 分配。这些发现凸显了对器官分配进行更严格监督的必要性，并强调了器官获取与移植网络确保正确数据报告的责任。
