Dual Kidneys Concept Paper 201701

Proposal overview

Sponsoring Committee: Kidney Transplantation

Strategic Goal: Increase the number of transplants

Problem statement

By the conclusion of 2016, a record-setting 12,2451 deceased donor kidneys transplants were performed nationwide. However, there were still 98,962 candidates on the kidney waiting list waiting for a kidney transplant.2 One strategy to increase the number of kidney transplants is to reduce the number of discards through dual kidney transplantation. The OPTN/UNOS Kidney Transplantation Committee (“the Committee”) is considering amendments to current OPTN policy in support of optimizing dual kidney allocation. Because dual kidney and high Kidney Donor Profile Index (KDPI) transplants are disproportionately performed more often in older recipients, expanding the use of dual kidney transplantation of high KDPI kidneys may counterbalance the modest decline in access for older patients that was evident after the new kidney allocation system (KAS) was implemented in December 2014. Dual transplants and high KDPI transplants are disproportionately performed more often in older recipients; expanding the use of dual transplantation of high KDPI kidneys could serve to counterbalance the modest decline in access for older patients post-KAS.3 Furthermore, studies and OPTN data analyses have shown that two high KDPI kidneys have a significant survival advantage over one. Amending policy and enhancing programming could increase use of high KDPI kidneys that are currently at increased risk for discard.

Members have indicated current policy is ambiguous, out of date, and does not enable timely identification and allocation of kidneys suitable for dual transplantation. As a result, dual kidneys often endure long cold ischemic times. Transplant programs, especially those with expertise in dual transplantation, would prefer to receive dual kidney offers earlier (ideally pre-organ recovery) to both allow time for planning and to minimize cold ischemic times. Likewise, OPOs favor pre-recovery criteria to facilitate allocation more efficiently.

The Committee seeks public input regarding three concepts that aim to address the above problems. It is important to note that this document is not a policy proposal. This concept paper is intended to inform all interested parties about the status of the Committee’s discussions and seek valuable input for further consideration. The Committee plans to circulate a policy proposal during the public comment cycle in the fall of 2017.

  1. “Data – OPTN," United Network for Organ Sharing, https://hrsa.gov/optn/data-calculators. Accessed December 14, 2016.
  2. Ibid
  3. Stewart, Darren E. & A. Kucheryavaya, Beck, J. One Year Evaluation of the New National Kidney Allocation System (KAS). OPTN/UNOS Monitoring Plan Final report. Prepared for the OPTN KAS Implementation Committee of the Kidney Transplantation Committee, April 18, 2016.

Background

Specific Feedback Requested (1/2017)

The Committee seeks community feedback on which of the three concepts, described below, would best improve utilization of high KDPI kidneys through dual kidney transplantation? What are the drawbacks to each concept?

Members are also asked to comment on both the immediate and long term budgetary impact, if applicable, of resources that may be required if their preferred concept is approved. This information assists the Board in considering the proposal and its impact on the community.

Read the full proposal (PDF - 265 KB)

Related proposal: Improving en bloc kidney allocation

View a recording of a January 31 webinar

Proposals Presented:

  • Improving Allocation of En Bloc Kidneys
  • Concept Paper: Improving Allocation of Double Kidneys

Comments

The comment period for this proposal is now closed.

Date Last Reviewed: