New national allocation policy for deceased donor kidneys in the United States and possible effect on patient outcomes.
In 2013, the Organ Procurement and Transplantation Network in the United States approved a new national deceased donor kidney allocation policy that introduces the kidney donor profile index (KDPI), which gives scores of 0%-100% based on 10 donor factors. Kidneys with lower KDPI scores are associated with better post-transplant survival. Important features of the new policy include first allocating kidneys from donors with a KDPI≤20% to candidates in the top 20th percentile of estimated post-transplant survival, adding waiting time from dialysis initiation, conferring priority points for a calculated panel-reactive antibody (CPRA)>19%, broader sharing of kidneys for candidates with a CPRA≥99%, broader sharing of kidneys from donors with a KDPI>85%, eliminating the payback system, and allocating blood type A2 and A2B kidneys to blood type B candidates. We simulated the distribution of kidneys under the new policy compared with the current allocation policy. The simulation showed increases in projected median allograft years of life with the new policy (9.07 years) compared with the current policy (8.82 years). With the new policy, candidates with a CPRA>20%, with blood type B, and aged 18-49 years were more likely to undergo transplant, but transplants declined in candidates aged 50-64 years (4.1% decline) and ≥65 years (2.7% decline). These simulations demonstrate that the new deceased donor kidney allocation policy may improve overall post-transplant survival and access for highly sensitized candidates, with minimal effects on access to transplant by race/ethnicity and declines in kidney allocation for candidates aged ≥50 years.
Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota; Department of Medicine, Hennepin County Medical Center, and Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota; isran001@umn.edu.
Ajay K
AK
Israni
Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota;
Nicholas
N
Salkowski
Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota;
Sally
S
Gustafson
Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota; Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota;
Jon J
JJ
Snyder
Departments of Medicine and Surgery, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois;
John J
JJ
Friedewald
Department of Medicine and Department of Surgery, Yale University School of Medicine, New Haven, Connecticut; and.
Richard N
RN
Formica
Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota;
Xinyue
X
Wang
Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota;
Eugene
E
Shteyn
United Network for Organ Sharing, Richmond, Virginia.
Wida
W
Cherikh
United Network for Organ Sharing, Richmond, Virginia.
Darren
D
Stewart
United Network for Organ Sharing, Richmond, Virginia.
Ciara J
CJ
Samana
Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota;
Adrine
A
Chung
Department of Medicine, Hennepin County Medical Center, and.
Allyson
A
Hart
Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota; Department of Medicine, Hennepin County Medical Center, and.
Bertram L
BL
Kasiske
D000367:Age Factors; D046148:Donor Selection / Q000458:organization & administration; D006085:Graft Survival; D006291:Health Policy; D006304:Health Status; D006801:Humans; D016030:Kidney Transplantation; D009927:Tissue and Organ Procurement / Q000458:organization & administration*; D014481:United States; D014850:Waiting Lists