Addressing medically urgent candidates in the new kidney allocation system

Toolkit

Background

Policy

Post-implementation monitoring

FAQs & resources

Background

At its December 2019 meeting, the OPTN Board of Directors approved a policy to remove DSA, and region from kidney and pancreas allocation. This change impacted previous medical urgency policies by eliminating Policy 8.2.a: Exceptions Due to Medical Urgency.

To address this, the OPTN Board of Directors approved an additional policy at its June 2020 meeting that provides a new definition of medical urgency and also ensures medically urgent candidates receive allocation priority in the newly approved framework.

Policy

Summary of policy changes

• This policy creates a Medically Urgent classification within all kidney allocation tables.
• The classification creates priority for candidates at imminent risk of death due to an inability, or anticipated inability, to accept dialysis treatment for renal failure.
• In order to be placed into the new classification, a candidate must meet medical eligibility criteria (as defined in the policy) that indicates imminent or complete loss of dialysis access.
• The location of the Medically Urgent classification varies in priority across each of the four kidney donor profile index, or KDPI, sequences in allocation policy. See table below for details.
  

  Sequence A KDPI 0-20% (and en bloc)	Sequence B KDPI 20-34%
  100% Highly Sensitized Inside Circle Prior Living Donor Inside Circle PediatricsMedically urgent sorted above non-medically urgent Inside Circle Medically UrgentProposed medical urgency classification 98%-99% Highly Sensitized 0-ABDRmm Inside Circle Top 20% EPTS 0-ABDRmm (ALL) Inside Circle (All) National Pediatrics National (Top 20%) National (All)	100% Highly Sensitized Inside Circle Prior Living Donor Inside Circle PediatricsMedically urgent sorted above non-medically urgent Inside Circle Medically UrgentProposed medical urgency classification 98%-99% Highly Sensitized 0-ABDRmm Inside Circle Safety Net Inside Circle (All) National (All)

  Sequence C KDPI 35-85%	Sequence D KDPI 86-100%
  100% Highly Sensitized Inside Circle Prior Living DonorMedically urgent sorted above non-medically urgent Inside Circle Medically UrgentProposed medical urgency classification 98%-99% Highly Sensitized 0-ABDRmm Inside Circle Safety Net Inside Circle (All) National (All) Inside Circle (dual) National (dual)	100% Highly SensitizedMedically urgent sorted above non-medically urgent Inside Circle Medically UrgentProposed medical urgency classification 98%-99% Highly Sensitized 0-ABDRmm Inside Circle Safety Net Inside Circle (All) Inside Circle (dual) National (All) National (dual)

  Medically urgent sorted above non-medically urgent

  Medically urgent classification

  Classification below proposed medical urgency classification

  Sequence A KDPI 0-20% (and en bloc)	Sequence B KDPI 20-34%	Sequence C KDPI 35-85%	Sequence D KDPI 86-100%
  100% Highly Sensitized Inside Circle Prior Living Donor Inside Circle PediatricsMedically urgent sorted above non-medically urgent Inside Circle Medically UrgentProposed medical urgency classification 98%-99% Highly Sensitized 0-ABDRmm Inside Circle Top 20% EPTS 0-ABDRmm (ALL) Inside Circle (All) National Pediatrics National (Top 20%) National (All)	100% Highly Sensitized Inside Circle Prior Living Donor Inside Circle PediatricsMedically urgent sorted above non-medically urgent Inside Circle Medically UrgentProposed medical urgency classification 98%-99% Highly Sensitized 0-ABDRmm Inside Circle Safety Net Inside Circle (All) National (All)	100% Highly Sensitized Inside Circle Prior Living DonorMedically urgent sorted above non-medically urgent Inside Circle Medically UrgentProposed medical urgency classification 98%-99% Highly Sensitized 0-ABDRmm Inside Circle Safety Net Inside Circle (All) National (All) Inside Circle (dual) National (dual)	100% Highly SensitizedMedically urgent sorted above non-medically urgent Inside Circle Medically UrgentProposed medical urgency classification 98%-99% Highly Sensitized 0-ABDRmm Inside Circle Safety Net Inside Circle (All) Inside Circle (dual) National (All) National (dual)

  Medically urgent sorted above non-medically urgent

  Medically urgent classification

  Classification below proposed medical urgency classification

• A candidate’s status as Medically Urgent as defined in new policy requires members to submit supporting documentation to the OPTN within seven (7) business days. 
• Details about how to submit medical urgency supporting documentation can be found on UNet℠. Professional education is available on UNOS Connect. 
• Find information about post-implementation monitoring below.
• Find details about all changes to medical urgency classifications in the policy notice below.

Policy documents

• Addressing Medically Urgent Candidates in the New Kidney Allocation System
  • Read the policy proposal
  • Read the Board briefing paper
  • Read the policy notice
  • Read public comment on Addressing Medically Urgent Candidates in the new Kidney Allocation System

Post-implementation monitoring

The language does not change the current routine monitoring of OPTN members. All policy requirements and data entered in UNet^SM may be subject to review by the OPTN contractor, and members are required to provide documentation as requested.

OPTN staff will monitor and compile cases utilizing the medical urgency status. On a quarterly basis, the Kidney Transplantation Committee will review all uses of the medical urgency classification and priority status. The MPSC will review all relevant information to determine if a policy noncompliance has occurred and what type of action, if any, is warranted.

FAQs & resources

Instruction

• Professional education is available on UNOS Connect.

  • KID112 - Removing DSA and Region from Kidney and Pancreas Allocation
  • KID113 - Medical Urgency Data Collection Period (previously Phase 1)
  • KID114 - Medically Urgent Status for Adult and Pediatric Candidates (previously Phase 2)

Frequently asked questions

• Frequently asked questions about the removal of DSA and OPTN region from kidney and pancreas allocation

Patient resources

• A Nov. 23, 2020, webinar for transplant patients and their caregivers hosted by the OPTN Kidney and Pancreas Transplantation Committees discussed the changes. A recording is available here. 

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