New Study Finds Disparities in Out-of-sequence Distribution of Donated Kidneys

A new national study published in JAMA Internal Medicine highlights significant socioeconomic disparities in the out-of-sequence distribution of deceased donor kidneys. The findings suggest that these permissible deviations from the standard allocation algorithm have not been equitably applied and may have undermined efforts to maximize organ utilization. Between 2020 and 2023, the number of out-of-sequence deceased donor kidney transplants (DDKTs) in the United States increased nearly ninefold—from 342 cases (2% of all DDKTs in 2020) to 2,927 cases (16% in 2023). During that same period, the proportion of discarded kidneys rose by 6.8%. The study found that recipients of out-of-sequence kidney allocations were more likely to be older, of Hispanic ethnicity, privately insured, and not reliant on pretransplant dialysis—raising concerns about equity in access to life-saving transplants.