Effect of Kidney Allocation Policy Changes and Organ Donor Hospital Geographic Location on Deceased Donor Kidney Nonuse

Background. Deceased donor kidney recovery and transplantation is a multistep, time-sensitive process, and recovering organs from donors in distant regions may pose logistical challenges. The effect of donor hospital location on kidney utilization outcomes, and whether allocation policy modifies this effect, remains unknown. Methods. We used Organ Procurement and Transplantation Network data to assemble a cohort of deceased kidney donors recovered between January 1, 2010, and December 31, 2024. We categorized the cohort into 3 eras based on allocation policy: before kidney allocation system (pre-KAS) in January 1, 2010–December 4, 2014, December 5, 2014–March 14, 2021 (KAS), and March 15, 2021–December 31, 2024 (KAS250). Our main exposures included estimated driving time, categorized into quartiles, between organ procurement organization (OPO) headquarters and donor hospital, and the allocation era. Results. The final cohort comprised 153 551 deceased kidney donors. The median travel time from OPO headquarters to hospitals was 41 min (interquartile range, 15.1–111.8). In contrast to our hypothesis, nonuse of kidneys from donors in the farthest quartile (versus the closest) was lower when compared with the nearest quartile (odds ratio, 0.94; 95% confidence interval, 0.90-0.98). The adjusted odds ratio of kidney nonuse was slightly higher in KAS250 (odds ratio, 1.03 versus KAS; 95% confidence interval, 1-1.06), but this decreased by 2024 to its lowest level since 2010. Conclusions. In summary, the geographic location and driving time between the donor hospital and the OPO headquarters were not associated with an increased risk of kidney nonuse. The adjusted odds ratio of kidney nonuse continues to decline and is at the lowest level since 2010.