No Kidney Left Behind: Rescuing Unused Donor Kidneys for Transplant at the First Centralized Assessment and Repair Center

Rescue of non-used kidneys may be facilitated using sub-normothermic acellular machine perfusion (SNAP), which can prolong safe preservation times and provide additional viability assessment. While blood-based normothermic machine perfusion (NMP) has been utilized internationally, barriers to adoption of NMP in the US include limited availability, staffing and facility resource limitations, geographic distances between donor and recipient hospitals, blood shortages, and reliance on hypothermic machine perfusion (HMP). To overcome obstacles to adoption, the first centralized kidney Assessment and Repair Center (ARC) was established in West Lafayette, Indiana. Organized as an independent public benefit company, this center was designed to provide sub-normothermic acellular perfusion (SNAP) and assessment services to rescue unused/hard-to-place (HTP) kidneys. An acellular, human serum albumin-based perfusate was chosen, and a second cold ischemic time (CIT) was validated during pre-clinical testing. Between April 2024- May 2025, 158 unused deceased donor kidneys were transported to the ARC, resulting in 142 transplants (90%) after SNAP assessment. SNAP is feasible when performed by a centralized ARC and reduces kidney discard rates by providing objective viability assessment data. Moreover, SNAP allows for extended preservation times of nearly 70 h, enabling improved logistical planning and broader sharing of deceased donor kidneys.