J Am Soc Nephrol. 2014 May 15. pii: ASN.2013070784. [Epub ahead of print]

New National Allocation Policy for Deceased Donor Kidneys in the United States and Possible Effect on Patient Outcomes.

Israni AK1, Salkowski N2, Gustafson S2, Snyder JJ3, Friedewald JJ4, Formica RN5, Wang X2, Shteyn E2, Cherikh W6, Stewart D6, Samana CJ6, Chung A2, Hart A7, Kasiske BL8.

Author information

• 1Scientific 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.
• 2Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota;
• 3Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota; Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota;
• 4Departments of Medicine and Surgery, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois;
• 5Department of Medicine and Department of Surgery, Yale University School of Medicine, New Haven, Connecticut; and.
• 6United Network for Organ Sharing, Richmond, Virginia.
• 7Department of Medicine, Hennepin County Medical Center, and.
• 8Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota; Department of Medicine, Hennepin County Medical Center, and.

Abstract

In 2013, the Organ Procurement and Transplantation Network in the United States approved a new national deceased donor kidney allocation policythat 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.