The Ripple Effects of Delayed Graft Function

The number of people with end-stage kidney disease requiring renal replacement therapy is growing at a faster rate than the number of kidneys available for transplant. Additional options for deceased donor kidney transplant will increase risk for delayed graft function, which has expansive clinical, performance, and financial implications. The purpose of this paper is to discuss how delayed graft function impacts different domains.

Given that most kidney transplants in the USA are performed with deceased donors, expanding the deceased donor pool is likely to be of the highest impact. The potential additional sources of deceased donors include increasing organ donation in general and willingness to change perspectives about acceptable kidneys for transplant. An important implication of expanding criteria for acceptable kidneys for transplant is the risk for delayed graft function, what is expected, and how do we manage a potential increase burden for patients, transplant centers, and organ procurement organizations. Given the directives of Advancing American Kidney Health policies, it is important that we are thorough and thoughtful about navigating the post-transplant experience for patients and providers. The breadth of impact ranges from exploring the additional resources patients require to manage the social and financial complications associated with delayed graft function to balancing transplant centers’ challenge to provide excellent clinical care in a standard fashion against desire to transplant all eligible candidates.

This paper summarizes the historical approach to delayed graft function and proposes a dynamic framework for an improved system to review impact to the multiple stakeholders.