8.5 Patients Die Each Day Waiting for Transplants... "Donor Organ Allocation Criteria Must Change"

Korea National Institute of Health and KOTRY Track More Than 26,500 Transplant Patients

Transplanting a Poor-Condition Kidney into a Suitable Patient Lowers Risk of Death by 58%

Precision Transplant Medicine Using AI and Genomic Data Also in the Works

Transplanting a kidney in relatively poor condition into a patient suited to receive it can reduce the risk of death by 58% compared with remaining on the waiting list. With an average of 8.5 patients dying each day in South Korea while waiting for an organ transplant, a study has found that the scope of donor organ use should be expanded and allocation criteria improved to account for patients' chances of survival.

The Korea National Institute of Health and the Korean Organ Transplantation Registry (KOTRY) held a press briefing at Severance Hospital in Seodaemun-gu, Seoul, on November 6 and presented findings from a 12-year follow-up study of 26,571 patients who received transplants of five organs: kidneys, livers, hearts, lungs, and pancreases.

KOTRY is a national organ transplant cohort research project launched in 2014 with support from the Korea National Institute of Health. To date, 88 organ transplant centers across the country have participated, compiling clinical data on 15,167 kidney, 9,058 liver, 1,349 heart, 670 lung, and 327 pancreas transplant patients.

According to the Korea Organ Donation Agency and the National Organ, Tissue and Blood Management Agency, the imbalance between demand for and supply of organs for transplantation in South Korea is worsening. In 2024, 3,096 people died while waiting for an organ transplant, up 41.3% from 2,191 in 2020. Meanwhile, the number of brain-dead organ donors fell from 478 in 2020 to 370 in 2025. The consent rate among donor families was just 31.2% in 2024.

The researchers focused on the potential to use donor organs by considering not only the condition of the organ but also the health of the recipient and their expected survival. Rather than hesitating to transplant an organ because the donor is older or the organ is in relatively poor condition, they said decisions about its use should be based on actual survival outcomes after transplantation.

KOTRY first developed the Korean Kidney Donor Profile Index (K-KDPI), which assesses the condition of a donor kidney, and the Korean Estimated Post-Transplant Survival (K-EPTS) score, which estimates the expected survival of patients on the transplant waiting list. It then analyzed the transplant outcomes of expanded-criteria donor kidneys with a K-KDPI of 70% or higher. The analysis found that for wait-listed patients aged 40 or older who had no antibody sensitization and no diabetes, receiving one of these kidneys was associated with a 58% lower risk of death than continuing to wait. These patients accounted for 45.6% of all those on the waiting list. This suggests that transplanting a kidney in relatively poor condition into a suitable patient may offer a better chance of survival than waiting.

The study also raised the need to review the emergency-focused allocation system for heart transplants. In South Korea, hearts are currently prioritized for critically ill patients dependent on extracorporeal membrane oxygenation (ECMO). However, an analysis of 1,021 heart transplant recipients from 2014 to 2023 found that the in-hospital mortality rate was 17.9% for patients who received a transplant while on ECMO, compared with 4.4% for patients who received a transplant using a left ventricular assist device (LVAD) and 4.4% for those who received a transplant without a separate assist device. Patients transplanted while on ECMO also had a 3.7 times higher risk of severe early graft dysfunction.

There was insufficient evidence to restrict access to transplantation solely because a patient was older. An analysis of 628 heart transplant recipients from 2015 to 2020 found no difference in survival rates between patients aged 65 or older who were able to walk and younger patients. This underscores the importance of assessing actual physical function and health rather than age.

Professor Yang Jaeseok of the Division of Nephrology at Severance Hospital, principal investigator of the Korea Organ Transplantation Registry (KOTRY), presents findings from 12 years of cohort research on organ transplantation at a press briefing held at Severance Hospital in Seodaemun-gu, Seoul, on the 6th.

Livers from Hepatitis B-Positive Donors Can Also Be Used for Transplantation

Research has also explored expanding the use of donor organs that were previously avoided. Among 4,265 adult liver transplant recipients, researchers analyzed 20 patients who received livers from donors who tested positive for the hepatitis B surface antigen. There was no difference in patient survival or liver graft survival compared with recipients of livers from donors who tested negative. Livers from positive donors are currently restricted to positive recipients, but the findings could provide a basis for expanding their use, provided that infection prevention and management measures are in place, the researchers said.

However, these research findings will not immediately lead to changes in policy. Kim Myeongsu, president of the Korean Society for Transplantation, executive director of KOTRY, and a professor at Yonsei University College of Medicine, said, "To change organ allocation principles, we need to gather and analyze sufficient data to determine which criteria reduce deaths among people waiting for transplants and improve outcomes after transplantation." He added, "In the United States, allocation rules are changed only after tens of thousands of people have been followed for 10 years and the evidence has been established."

Starting this year, research into precision transplant medicine using artificial intelligence (AI) and genomic data will also get underway in earnest. Using data from 4,854 kidney transplant patients, KOTRY analyzed key factors affecting death within one year of transplantation and acute rejection. It also developed an AI-based kidney cortex analysis model using computed tomography (CT) scans from 1,074 kidney donors. The project plans to link cohort data with national public data, including health insurance, death, and cancer registration records, to track patients' long-term outcomes even if they change hospitals or receive another transplant.

Yang Jaeseok, a professor of nephrology at Severance Hospital and principal investigator of the study, said, "An organ transplant cohort is like social infrastructure that accumulates records of the lives of patients and donors." He added, "We will incorporate quality of life that patients and their families can feel into our research, and work to ensure that the accumulated data contributes to actual clinical care and policy."

This content was produced with the assistance of AI translation services.