Sibulesky L, Kaufman DM, Bakthavatsalam R, Leca N, Perkins JD. Rethinking procurement biopsy in donors with normal renal function: A barrier to kidney utilization without survival benefit. World J Transplant 2026; 16(2): 118088 [DOI: 10.5500/wjt.v16.i2.118088]
Corresponding Author of This Article
Lena Sibulesky, MD, Associate Professor, Division of Transplant Surgery, Department of Surgery, University of Washington Medical Center, 1959 NE Pacific Street, Seattle, WA 98195, United States. lenasi@uw.edu
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Transplantation
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research-article
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Sibulesky L, Kaufman DM, Bakthavatsalam R, Leca N, Perkins JD. Rethinking procurement biopsy in donors with normal renal function: A barrier to kidney utilization without survival benefit. World J Transplant 2026; 16(2): 118088 [DOI: 10.5500/wjt.v16.i2.118088]
World J Transplant. Jun 18, 2026; 16(2): 118088 Published online Jun 18, 2026. doi: 10.5500/wjt.v16.i2.118088
Rethinking procurement biopsy in donors with normal renal function: A barrier to kidney utilization without survival benefit
Lena Sibulesky, Daniel M Kaufman, Ramasamy Bakthavatsalam, Nicolae Leca, James D Perkins
Lena Sibulesky, Ramasamy Bakthavatsalam, James D Perkins, Division of Transplant Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA 98195, United States
Daniel M Kaufman, Division of Transplant Surgery, Department of Surgery, St. Vincent Hospital, Indianapolis, ID 46260, United States
Nicolae Leca, Department of Nephrology, University of Washington Medical Center, Seattle, WA 98195, United States
Co-first authors: Lena Sibulesky and Daniel M Kaufman.
Author contributions: Sibulesky L and Perkins JD designed and performed the research study; Kaufman DM, Bakthavatsalam R, and Leca N wrote the manuscript; Sibulesky L and Kaufman DM contributed equally to this manuscript and are co-first authors. All authors approval the final manuscript.
Institutional review board statement: According to the Institutional Review Board regulations, our article, which is related to the Organ Procurement and Transplantation Network dataset study, does not require Institutional Review Board approval.
Informed consent statement: This is a retrospective study; therefore, informed consent is not required, and the need for informed consent has been waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement:
Organ Procurement and Transplantation Network data were obtained from files released April 11, 2025. As these data are de-identified and publicly available, the Division of Human Subjects University of Washington classified this study as exempt from human subjects’ review.
Corresponding author: Lena Sibulesky, MD, Associate Professor, Division of Transplant Surgery, Department of Surgery, University of Washington Medical Center, 1959 NE Pacific Street, Seattle, WA 98195, United States. lenasi@uw.edu
Received: December 23, 2025 Revised: January 5, 2026 Accepted: February 14, 2026 Published online: June 18, 2026 Processing time: 157 Days and 14.7 Hours
Core Tip
Core Tip: Using national Organ Procurement and Transplantation Network data, we show that procurement biopsy in deceased donors with preserved renal function does not improve prognostic accuracy or graft survival. Instead, biopsy is associated with substantially higher discard rates and prolonged cold ischemia, with much of its adverse impact mediated through ischemic delay and early graft dysfunction. Advanced analytic approaches, including mediation, restricted mean survival time, and decision-curve analyses, demonstrate no added clinical benefit beyond standard donor and recipient characteristics. These findings challenge routine procurement biopsy in this donor population and support re-evaluating biopsy-driven acceptance practices to improve kidney utilization.
