ABSTRACT
Background
Kidney transplant programs may remove high‐risk patients from the national transplant waiting list to mitigate peri‐transplant complications and enhance overall post‐transplant survival. The phrase “too sick,” frequently reported to the Organ Procurement and Transplantation Network (OPTN) as a reason for removal, lacks precision and specificity. Furthermore, there is limited information regarding the survival outcomes of patients who have been delisted and are consequently ineligible for a kidney transplant. In this study, we describe the specific reasons for delisting and investigate subsequent survival outcomes after being removed from the waiting list.
Methods
Data were collected from patients 18 years and older removed from the renal transplant waiting list between January 2011 and December 2015. Delisting categorization divided patients into a medical group (removed for clinical reasons such as cardiovascular disease, malignancy, or severe iliac calcification) and a psychosocial group (removed for issues such as patient request, non‐compliance, insurance loss, or loss of contact). The primary endpoints were 5‐year survival and restricted mean survival time (RMST) at 5 years.
Results
Out of 240 eligible patients, 124 patients (51.7%) were delisted for medical reasons and 116 (48.3%) were delisted for psychosocial reasons. Upon investigation, the primary reason for removal from the transplant waiting list among the medical group was cardiovascular (CV)‐related comorbidities (44, 35.5%). 55% of the total number of patients delisted survived for 5 years. Patients delisted for medical reasons exhibited a 5‐year survival rate of 43% and a RMST of 3.3 years. Specifically, patients delisted for CV‐related reasons had a 5‐year survival rate of 44%. In contrast, patients delisted for psychosocial reasons had a higher 5‐year survival rate of 70% and a longer RMST of 4.31 years (p‐value < 0.001). At 5 years following delisting, patients diagnosed with coronary artery disease (CAD) exhibited a 51% survival rate, which was significantly lower compared to those without CAD with a survival rate of 57% (p = 0.046).
Conclusion
Cardiovascular disease remains the leading cause of delisting from the kidney transplant waiting list. However, many delisted patients demonstrated longer survival than expected. Further studies are needed to clarify the impact of delisting decisions on outcomes and to guide more informed, patient‐centered transplant practices.
Keywords: delisting, kidney transplant, survival, waitlist
1. Introduction
Kidney transplantation is the treatment of choice for eligible patients with end‐stage kidney disease (ESKD), offering a significant survival benefit and improvement in quality of life over dialysis [1, 2, 3, 4]. To ensure patient safety and enhance post‐transplant outcomes, kidney transplant candidates undergo a thorough evaluation prior to their inclusion on the national transplant waiting list and necessitate continuous monitoring for clinical progression from the time of listing until the potential transplantation date. When peri‐transplant risks are deemed to surpass anticipated benefits, candidates may be delisted, which is defined as their removal from the national transplant waiting list [5, 6].
Currently, the Organ Procurement and Transplantation Network (OPTN) does not require transplant programs to report patient data or clinical rationale upon delisting. Furthermore, delisting reasons are often nonspecific and vague, including patients being deemed ‘too sick to transplant’ with no disclosure of guided medical contraindication [7].
Limited data exists on the proportion of candidates who are delisted, the specific reasons for their removal, and their outcomes after delisting. Most evidence comes from single‐center studies complicating overall validity [7, 8, 9]. Furthermore, delisting practices are inconsistent and poorly standardized, with rates varying significantly by center volume [7, 10]. Identifying the reasons for delisting may help refine waitlist management, guide the allocation of resources toward patients at high risk for removal, and prompt a critical reevaluation of delisting decisions.
To our knowledge, this is the first study which assessed the specific reason for ineligibility and further compared patient survival between groups delisted for reported medical versus psychosocial reasons. The aims of this study were to: [1] Evaluate the specific reasons for delisting from the adult kidney transplant waiting list [2] Analyze the survival rates of patients after delisting.
2. Materials and Methods
2.1. Study Design and Patient Selection
All adult patients (aged ≥18 years) who were removed from the kidney transplant waiting list at our institution between January 2011 and December 2015 were eligible for inclusion. Patients delisted due to improvement in renal function or those listed for combined organ transplantation (including liver or pancreas) were excluded. Patients were divided into two groups according to the primary reason for delisting. The Medical group included patients removed for clinical contraindications such as cardiovascular disease, malignancy, severe iliac artery calcification, or obesity, defined as body mass index (BMI) > 35 kg/m2. The Psychosocial group consisted of patients delisted for non‐medical reasons, including patient request, non‐adherence, loss of insurance coverage, or loss of contact. Delisting decisions were made through consensus at weekly multidisciplinary selection committee meetings, which included transplant surgeons, nephrologists, psychologists, social workers, and pharmacists.
2.2. Data Collection
Following a comprehensive review of patient medical records, the following variables were systematically extracted: age, body mass index (BMI), sex, race, primary etiology of end‐stage renal disease (ESRD), and baseline comorbidities, including coronary artery disease and congestive heart failure. Blood group (A, B, O, AB) was also documented. Additional clinical parameters included age at the time of listing, age at delisting, total duration of listing, specific reasons for delisting, and history of prior kidney transplantation. This study protocol received approval from the Institutional Review Board of the Medical College of Wisconsin.
2.3. Survival Analyses
Overall survival after removal from the kidney transplant waiting list was the primary outcome and was assessed for up to 5 years. Survival time was defined as the interval from delisting to death, with patients censored at the date of last documented follow‐up. Overall survival was estimated using the Kaplan–Meier method.
Restricted mean survival time (RMST) at 5 years was used as a complementary, cohort‐level summary of survival. RMST represents the expected survival time accrued to a prespecified time point and is calculated as the area under the survival curve. RMST was selected because it provides an absolute and clinically interpretable measure of survival that does not depend on proportional hazards assumptions and remains informative when median survival is not reached.
A multivariable Cox proportional hazards model was used to evaluate associations between patient characteristics and post‐delisting survival. Thirty‐three patients (16 medical and 17 psychosocial) were lost to follow‐up after delisting and not as the cause of delisting. These patients were censored at the date of last known contact.
Mortality status was determined from the electronic medical record and institutional follow‐up data; linkage to external mortality databases was not performed.
Statistical analyses were conducted using Stata/SE v14.2 (StataCorp LLC, College Station, TX) and R v4.0.2 (R Foundation for Statistical Computing, Vienna, Austria).
3. Results
A total of 260 ESKD patients were removed from the kidney transplantation waiting list during the study period. Of those, twenty patients were excluded from the study: ten were identified as candidates for a combined liver and kidney transplant due to hepatorenal syndrome, five patients listed for combined kidney pancreas transplant, and the final five following the observed improvement of their kidney function. The final study cohort comprised 240 patients, with 124 (51.7%) in the medical group and 116 (48.3%) in the psychosocial group Figure 1 (Table 1 ).
FIGURE 1.
Flow diagram illustrating the patient cohort.
TABLE 1.
Characteristics of delisted patients from the kidney transplant waiting list, comparing medical reasons vs. psychosocial reasons.
| Factors | (n = 124) | Medical reasons (n = 116) | Psychosocial reasons | p‐value |
|---|---|---|---|---|
| Sex | 0.3 | |||
| Female | 46 (37%) | 51 (44%) | ||
| Male | 78 (63%) | 65 (56%) | ||
| BMI, mean (SD) | 29 (6.61) | 28 (5.59) | 0.2 | |
| 18–29 | 72, 58% | 75, 64.6% | ||
| 30–34 | 27, 22% | 23, 20% | ||
| 35–39 | 15, 12% | 14, 12% | ||
| >40 | 10, 8% | 4, 3.4 | ||
| Blood | 0.2 | |||
| O | 54 (45%) | 56 (48%) | ||
| A | 40 (33%) | 36 (31%) | ||
| B | 26 (21%) | 18 (16%) | ||
| AB | 1 (0.8%) | 6 (5.2%) | ||
| Unknown | 3 | 0 | ||
| Race | 0.053 | |||
| Black | 38 (31%) | 43 (37%) | ||
| White | 74 (60%) | 52 (45%) | ||
| Hispanic | 5 (4.0%) | 10 (8.6%) | ||
| Native | 3 (2.4%) | 1 (0.9%) | ||
| Asian | 4 (3.2%) | 10 (8.6%) | ||
| Primary ESRD cause | ||||
| HTN | 54 (43%) | 50 (43%) | ||
| DM | 15 (12%) | 14 (12%) | ||
| Combined HTN/DM | 46 (37%) | 30 (26%) | ||
| Other | 9 (8%) | 22 (19%) | ||
| Listing Criteria, mean (SD) | ||||
| Age at listing | 57.34 (10.37) | 48.66 (14.17) | < 0.001 | |
| Age at delisting | 61.05 (10.21) | 51.61 (14.06) | < 0.001 | |
| Listing duration | 3.73 (3.14) | 2.99 (2.32) | 0.04 | |
| Payor at time of listing | 0.57 | |||
| Medicare | 97 (78.2%) | 89 (76.7%) | ||
| Private | 20 (16.1%) | 23 (19.8%) | ||
| Medicaid | 7 (5.6%) | 4 (3.4%) |
The most common reason for delisting among patients in the medical group was cardiovascular (CV)‐related (44, 35.50%). Cancer‐related reasons for removal (27, 21.80%) were followed by severe Iliac artery calcification (25, 20.1%), physical deterioration (17, 13.80%), and obesity (11, 8.80%). The most frequent reason for delisting among the psychosocial group was patient request (57, 49%) followed by lost contact with the patient (25, 22%), non‐compliance (20, 17%), financial issues, and substance abuse (both in 7 patients, 6% each) (Table 2 ).
TABLE 2.
Reasons for edlisting from kidney transplant waiting list (January 1, 2011 ‐ December 31, 2015).
| Delisting reason | Number (%) | 5‐year survival (95% CI) | p‐value |
|---|---|---|---|
| Medical | 124 | 43% (34%, 53%) | < 0.001 |
| Cardiovascular | 44 (35.5%) | ||
| Cancer | 27 (21.8%) | ||
| Iliac calcification | 25 (20.1%) | ||
| Physical deterioration | 17 (13.8%) | ||
| Obesity | 11 (8.8%) | ||
| Psychosocial | 116 | 70% (61%, 81%) | |
| Patient request | 57 (49%) | ||
| Lost contact | 25 (22%) | ||
| Non‐compliance | 20 (17%) | ||
| Financial Issues | 7 (6%) | ||
| Substance abuse | 7 (6%) |
3.1. Listing Parameters
The mean age of listing, the mean age of delisting and the listing duration were significantly lower for the psychosocial group in comparison to the medical group; 48.66 vs. 57.34, 51.61 vs. 61.05 and 2.99 vs, 3.73 respectively (p‐value < 0.001) (Table 1). Patients with substance abuse and noncompliance were listed and delisted at a significantly younger age. However, iliac calcification and physical deterioration, as reasons for delisting, were listed at older ages. In addition, patients who were removed from the list due to cancer‐related causes spent a significantly greater amount of time on the waitlist.
The age at listing, age at delisting and listing duration were inversely associated with 5‐year survival after delisting for medical reasons. The older the age at listing and delisting and the longer duration of listing were all associated with a lower 5‐year survival rate (Figure 2 ).
FIGURE 2.
Bivariate fit of 5‐year survival time from delisting for medical reasons, stratified by age at listing, age at delisting, and listing duration.
3.2. Survival Following Delisting
Overall, 55% of delisted patients were alive at 5 years, with an RMST of 3.76 years (95% CI, 3.6–4.1) (Figure 3 ). Patients who were delisted for medical reasons had 43% probability of survival at the 5‐year mark whereas patients delisted patients for psychosocial reasons had a 70% probability (Figure 4 ) (Table 2 ). The RMST for patients who were delisted for medical reasons was significantly less at 3.3 years while the RMST for patients who were delisted for psychosocial reasons was 4.31 years (p‐value < 0.001).
FIGURE 3.
Kaplan‐Meier analysis demonstrating overall survival in all delisted patients.
FIGURE 4.
Kaplan‐Meier analysis of overall survival in delisted patients stratified by medical and psychosocial reasons.
In multivariable Cox regression analysis, patients delisted for psychosocial reasons had a significantly lower risk of mortality compared to those delisted for medical reasons (HR 0.45, 95% CI 0.30–0.66; p < 0.001).
There was no significant difference between specific reasons for delisting and survival among medically delisted patients (Figure 5). Patients who were delisted due to obesity had the highest 5‐year survival rate at 60%. The 5‐year survival rate for patients delisted for reasons related to malignancy was 45% while the 5‐year survival rate for patients delisted for reasons related to CV disease was 44%. Iliac calcification and physical deterioration had the lowest 5‐year survival rates, coming in at 42% and 26%, respectively (Table 3 ).
FIGURE 5.
Kaplan‐Meier analysis of survival after delisting, stratified by specific medical reasons.
TABLE 3.
5‐Year survival for delisted patients due to medical reasons.
| Reason | 5‐year survival (95% CI) | 5‐year RMST | p‐value |
|---|---|---|---|
| 0.5 | |||
| Obesity | 60% (36%, 100%) | 3.78 | |
| Cancer | 45% (29%, 72%) | 3.60 | |
| CV | 44% (31%, 63%) | 3.43 | |
| Iliac calcification | 42% (26%, 70%) | 3.04 | |
| Physical deconditioning | 26% (10%, 66%) | 2.56 |
When examining specific reasons for delisting in a Cox model using cardiovascular causes as the reference, patient request (HR 0.43, 95% CI 0.23–0.80; p = 0.008) and loss of contact (HR 0.26, 95% CI 0.10–0.67; p = 0.005) were associated with significantly lower mortality risk. No other delisting reasons were significantly associated with mortality (Table 4).
TABLE 4.
Multivariable cox proportional hazards analysis of post‐delisting mortality by primary reason for delisting.
| Delisting reason | HR | 95% CI | p‐value |
|---|---|---|---|
| CV (Reference) | — | — | |
| Physical deconditioning | 1.76 | 0.87, 3.54 | 0.11 |
| Obesity | 0.71 | 0.29, 1.71 | 0.4 |
| Cancer | 0.99 | 0.54, 1.84 | > 0.9 |
| Iliac calcification | 0.98 | 0.51, 1.86 | > 0.9 |
| Patient request | 0.43 | 0.23, 0.80 | 0.008 |
| Non‐compliance | 0.68 | 0.34, 1.38 | 0.3 |
| Financial issues | 0.65 | 0.16, 2.75 | 0.6 |
| Lost contact | 0.26 | 0.10, 0.67 | 0.005 |
| Substance abuse | 0.54 | 0.16, 1.79 | 0.3 |
Note: Hazard ratios represent the relative risk of death after delisting. Hazard ratios < 1 indicate a lower risk of death compared with the reference group (cardiovascular‐related delisting), whereas hazard ratios > 1 indicate a higher risk of death.
Abbreviations: CI, confidence interval.;HR, hazard ratio.
Among all delisted patients, the presence of CAD emerged as a significant factor influencing survival outcomes. Patients with CAD had a 51% survival probability at 5 years, compared to 57% for patients without CAD (Figure 6). Additionally, patients with CAD exhibited a significantly higher Hazard Ratio (HR) of 3.34 (p = 0.046) compared to those without CAD. These findings highlight the detrimental impact of CAD on the long‐term survival of delisted patients. In contrast, no statistically significant difference in survival rates was observed between patients with and without congestive heart failure.
FIGURE 6.
Kaplan‐Meier analysis of survival in all delisted patients, stratified by coronary artery disease (CAD) status.
Duration of hemodialysis prior to delisting was not significantly associated with overall survival. Median dialysis duration was 42.3 months; 5‐year survival was 55% for patients with shorter duration (<42.3 months) and 49% for longer duration (≥42.3 months; p = 0.32) (Figure 7 ).
FIGURE 7.
Kaplan‐Meier analysis demonstrating effect of hemodialysis duration on survival.
Five‐year survival did not differ by sex (56% in males vs 54% in females). RMST was also similar (males: 3.61 years vs females: 3.96 years). Among all patients, there did not appear to be a statistically significant difference in survival risk based on race, previous history of kidney transplant, or blood type. Moreover, the BMI of a patient had no significant effect on their survival.
4. Discussion
The aging waiting list population and the associated increase in comorbidities pose significant challenges in terms of patient management and prioritization for kidney transplantation [7, 11, 12, 13]. The persistent organ shortage further pressures programs to select candidates with the highest likelihood of long‐term graft and patient survival [14]. This necessitates prioritizing healthier patients and potentially delisting patients with more complex medical conditions, including those with significant comorbidities who may not benefit from transplantation long‐term [14, 15].
As a result of many factors, waitlist management, including the extent to which patients are removed from the list, can lack clarity and disclosure [7, 16]. The system's ability to ensure that patients at each transplant program have comparable experiences and access to transplantation is called into question by the lack of established criteria [7]. Earlier research showed that there has been a significant escalation in the frequency of patients removed from the kidney transplant waiting list for being “too sick for transplant” [14, 15]. This observation reflects a meaningful increase in the prevalence of factors and comorbidities that render these patients’ ineligible for transplantation [16]. A recent study by Sokas et al. has shed light on the prognosis of patients who have been delisted for kidney transplantation [16]. The findings of Sokas et al. study demonstrated that a significant proportion of these patients, even after being delisted from the transplant waiting list, have a survival rate exceeding five years, indicating a substantial duration of life post‐delisting [16]. Furthermore, recent research showed that there are considerable differences in the mortality rate after delisting among kidney transplant programs [7].
Despite these broader trends, limited information exists on the proportion of candidates initially listed for kidney transplantation who are later deemed ineligible during waitlist maintenance [16]. In this retrospective, single‐center study involving 240 adult patients delisted between 2011 and 2015, our findings were consistent with prior studies examining reasons for waitlist removal and subsequent survival outcomes. Specifically, the present study identified cardiovascular disease as the leading medical cause of delisting, which is consistent with the well‐established high prevalence of CV disease among patients with ESKD (17–19). Cancer‐related conditions and severe iliac calcification were also common causes of delisting, findings that have likewise been consistently reported in previous studies [8, 9]. Notably, the prominent psychosocial reasons included patient requests, lost contact, and non‐compliance. When survival outcomes of patients with varying reasons for delisting were compared, our investigation found that 55% of delisted patients were still alive after 5 years of follow‐up, which is consistent with the findings of Sokas et al. [14]. These findings highlight the heterogeneity of post‐delisting survival, with many kidney transplant candidates demonstrating prolonged survival following removal from the waiting list. Severe iliac calcification, a manifestation of systemic cardiovascular disease, remains an underrecognized factor in transplant delisting despite its important clinical implications. Vascular calcification, a consequence of chronic kidney disease‐mineral and bone disorder, affects a substantial proportion of kidney transplant candidates and is strongly associated with CV morbidity and mortality in patients with ESKD (22–26). Peripheral vascular disease and iliac calcification are well established to negatively impact transplant and waitlist outcomes, and these challenges are expected to become increasingly common as transplant candidates become older and more medically complex (27–29).
In our cohort, severe iliac calcification accounted for a substantial proportion of medical delisting and was associated with increased mortality, although this finding did not reach statistical significance. Similarly, while dialysis duration prior to delisting was not significantly associated with survival, there was a trend toward lower 5‐year survival among patients with longer dialysis exposure, consistent with prior evidence linking prolonged dialysis to progressive cardiovascular deterioration and systemic complications. We also observed a 5‐year survival probability of 44% among patients delisted due to CV disease. Among all delisted patients, those with CAD had significantly lower 5‐year survival than those without CAD, and prior CABG was associated with increased mortality risk (HR 1.62). In contrast, patients delisted due to obesity demonstrated a 5‐year survival rate of 60%, exceeding initial prognostic expectations and suggesting more favorable long‐term outcomes than traditionally anticipated for this subgroup. This finding challenges the prevailing assumption that obesity uniformly predicts poor outcomes and highlights the need to reassess transplant eligibility criteria and waitlist protocols for obese patients. Collectively these findings highlight the complex interplay between CV comorbidity, vascular calcification, prolonged dialysis exposure, obesity, and transplant eligibility in patients with ESKD, underscoring the need for improved risk stratification and further investigation in larger cohorts.
Psychosocial factors accounted for nearly half of all delisting events in our cohort, with patient request, loss to follow‐up, and non‐compliance representing the most common causes. While the previously discussed medical causes for kidney transplant delisting have been relatively well described in prior literature, psychosocial causes remain comparatively underreported and poorly characterized despite their substantial impact on transplant eligibility and long‐term outcomes (29, 30). Existing studies have demonstrated that psychosocial variables, including inadequate social support, treatment nonadherence, substance use, and socioeconomic barriers, significantly influence waitlist access and transplant candidacy, although reporting of these factors varies considerably across transplant centers (29, 30). Our findings expand upon prior literature by providing a detailed characterization of psychosocial delisting patterns within a modern kidney transplant cohort and highlight the importance of further investigation into standardized psychosocial assessment and interventions aimed at reducing preventable waitlist removal.
Overall, our findings may help guide providers in managing patients with ESRD during their maintenance on the kidney transplant waiting list. The notable survival rates observed among delisted patients following their removal from the waiting list underscore the importance of comprehensive medical particularly cardiovascular assessments to facilitate timely kidney transplantation. Furthermore, these findings serve as an invitation to other transplant programs to examine the outcomes of delisted patients within their own contexts and advocate for improvements in reporting policies to the United Network for Organ Sharing (UNOS), enabling a more comprehensive understanding of delisted patients at a national level [7].
5. Limitations
One limitation of this study is the small sample size and limited time frame of the study period (January 2011 to December 2015). This may impact the generalizability of the findings to a broader population and may not capture long‐term trends or changes in delisted patients' outcomes over time. Survival among patients delisted for psychosocial reasons may be overestimated, as some may have subsequently received transplants at other centers. Furthermore, the study focuses on patients delisted from a specific kidney transplant program, which does not represent the diverse population of delisted patients in other transplant centers or regions. A multicenter study involving diverse transplant programs and patient populations would provide a more comprehensive understanding of the factors influencing delisting and the subsequent outcomes of delisted patients. Furthermore, the study primarily focused on survival outcomes, and other important aspects such as quality of life, healthcare utilization, and specific causes of mortality were not extensively explored. Future research should consider incorporating these additional measures to provide a more comprehensive assessment of the impact of delisting on patients' well‐being.
6. Conclusion
This study assessed the factors leading to removal from the kidney transplant waiting list and their effects on survival outcomes. Cardiovascular disease was the predominant medical rationale for delisting, with patients exhibiting coronary artery disease or a history of coronary artery bypass grafting facing an elevated mortality risk, underscoring the substantial impact of cardiovascular comorbidity on post‐delisting outcomes. These findings raise significant questions regarding contemporary delisting practices. A more comprehensive understanding of the determinants impacting delisting decisions could enhance transplantation accessibility for patients with ESKD. Enhanced cardiovascular evaluation and optimization may decrease unwarranted delisting and more closely align transplant candidacy decisions with predicted patient survival.
Funding
This research received no specific grant from any funding agency in the public, commercial, or not‐for‐profit sectors.
Conflicts of Interest
The authors declare no conflicts of interest relevant to this work.
Acknowledgments
The authors used ChatGPT (GPT‐5.2, OpenAI; accessed January 2026) to assist with grammar, language refinement, and proofreading of selected sections. All AI‐generated suggestions were thoroughly reviewed and verified by the authors before implementation, and no patient health information or extensive manuscript content was shared with the tool. The authors accept full responsibility for the final content.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request. The data are not publicly available due to privacy and ethical restrictions.
References
- 1. Tonelli M., Wiebe N., Knoll G., et al., “Systematic Review: Kidney Transplantation Compared with Dialysis in Clinically Relevant Outcomes,” American Journal of Transplantation 11, no. 10 (2011): 2093–2109. [DOI] [PubMed] [Google Scholar]
- 2. Rawashdeh B., AbuAssi M., Al‐Adwan Y., and El‐Hinnawi A., “A Bibliometric Analysis of the Most Cited Journal Articles in Kidney Transplantation,” The Cureus Journal of Medical Science 15, no. 4 (2023): 14. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Rawashdeh B., Hulse J., and Agarwal A., “Transplant of a Kidney from a Hepatitis C Viremic Donor to a Naive Recipient without Viral Transmission: A Case Report,” American Journal of Case Reports 22 (2021):e927532. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Rawashdeh B., AlRyalat S. A., Abuassi M., Prasad R., and Cooper M., “Unveiling Transplantation Research Productivity of United States: A Bibliometric Analysis,” World Journal of Transplantation 13, no. 6 (2023): 391–402. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Friedman S. E., Palac R. T., Zlotnick D. M., Chobanian M. C., and Costa S. P., “A Call to Action: Variability in Guidelines for Cardiac Evaluation Before Renal Transplantation,” Clinical Journal of the American Society of Nephrology 6, no. 5 (2011): 1185–1191. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6. Bhatti N. K., Karimi Galougahi K., and Paz Y., “Diagnosis and Management of Cardiovascular Disease in Advanced and End‐Stage Renal Disease,” Journal of the American Heart Association 5, no. 8 (2016):e003648. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7. Sokas C. M., Husain S. A., Xiang L., et al., “Evolving Metrics of Quality for Kidney Transplant Candidates: Transplant Center Variability in Delisting and 1‐Year Mortality,” Journal of the American College of Surgeons 234, no. 6 (2022): 1075–1081. [DOI] [PubMed] [Google Scholar]
- 8. Kianda M. N., Wissing K. M., Broeders N. E., et al., “Ineligibility for Renal Transplantation: Prevalence, Causes and Survival in a Consecutive Cohort of 445 Patients,” Clinical Transplantation 25, no. 4 (2011): 576–583. [DOI] [PubMed] [Google Scholar]
- 9. Holley J. L., Monaghan J., Byer B., and Bronsther O., “An Examination of the Renal Transplant Evaluation Process Focusing on Cost and the Reasons for Patient Exclusion,” American Journal of Kidney Diseases 32, no. 4 (1998): 567–574. [DOI] [PubMed] [Google Scholar]
- 10. Organ Procurement and Transplantation Network Removal Reasons by Year, http://optntransplanthrsagov/converge/latestData/rptDataasp. 2015.
- 11. Martins J., Barreto S., Bravo P., et al., “Kidney Transplant From Elderly Donors: A Center Experience,” Transplantation Proceedings 52, no. 5 (2020): 1265–1268. [DOI] [PubMed] [Google Scholar]
- 12. Perez‐Saez M. J., Gutierrez‐Dalmau A., Moreso F., Rodriguez Manas L., and Pascual J., “Frailty and Kidney Transplant Candidates,” Nefrologia (Engl Ed) 41, no. 3 (2021): 237–243. [DOI] [PubMed] [Google Scholar]
- 13. Thind A. K., Rule A., Goodall D., et al., “Prevalence of Frailty and Cognitive Impairment in Older Transplant Candidates—A Preview to the Kidney Transplantation in Older People (KTOP): Impact of Frailty on Outcomes Study,” BMC Nephrology [Electronic Resource] 23, no. 1 (2022): 283. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14. Lewis A., Koukoura A., Tsianos G. I., Gargavanis A. A., Nielsen A. A., and Vassiliadis E., “Organ Donation in the US and Europe: The Supply vs Demand Imbalance,” Transplant Rev (Orlando) 35, no. 2 (2021): 100585. [DOI] [PubMed] [Google Scholar]
- 15. Sterri A. B., Regmi S., and Harris J., “Ethical Solutions to the Problem of Organ Shortage,” Cambridge Quarterly of Healthcare Ethics 31, no. 3 (2022): 297–309. [DOI] [PubMed] [Google Scholar]
- 16. Sokas C., Cooper Z., Salim A., Rodrigue J. R., and Adler J. T., “Wait Expectations: The Impact of Delisting as an Outcome from the Kidney Transplant Waitlist,” Clinical Transplantation 35, no. 5 (2021): e14250. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request. The data are not publicly available due to privacy and ethical restrictions.