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Continuous Distribution - Kidney and Pancreas

The kidney and pancreas organ types began continuous distribution work in summer 2020. The Kidney and Pancreas Committees are on a parallel timeline to complete the development of the framework for each of their organ types.

Here you will find results of the work organized by the steps to build and implement the framework.

Flow chart that has a series of boxes as steps with an action inside each box. From first to last: identify attributes, categorize attributes, prioritize attributes against each other and convert attributes into points, build framework, modeling and analysis, public comment on policy proposal, board approval and the beginning of implementation. Flow chart that has a series of boxes as steps with an action inside each box. From first to last: identify attributes, categorize attributes, prioritize attributes against each other and convert attributes into points, build framework, modeling and analysis, public comment on policy proposal, board approval and the beginning of implementation.

1. Identify attributes

The Kidney and Pancreas Committees considered several attributes before deciding those that would comprise the overall composite allocation score. The identified attributes will align with NOTA and the OPTN Final Rule. In addition, any attribute that is based in part on a candidate’s location or listing is only permitted to the extent required by another regulatory factor. The Committees began with the attributes that are in current policy and considered additional attributes that will be suggested during summer 2021 public comment in the form of a concept paper.

  • 2021 kidney and pancreas concept paper – expected summer 2021 public comment

2. Assign values

Prioritize attributes against each other:
The specific weight of each attribute determines how much influence each attribute will have toward the overall score. This step has two parts:

  1. Community input will be collected to inform the Committees regarding weights of the attributes within the overall score. The community will be asked which attributes are most important to consider when prioritizing a candidate for an organ.
    • Community input – input request expected winter 2022
  2. Compare to “current state” through a revealed preference analysis. A revealed preference analysis involves looking at mathematical trends to review how multiple decisions have been made. For example, how important was distance compared to waiting time when a decision was made between two candidates? The analysis will take the current system and create a baseline to be measured against.
    • Revealed preference analysis – expected winter 2022

Convert attributes into points

For each attribute that will be factored into the overall score, the Kidney and Pancreas Committees will recommend how to assign points to candidates according to differences in the attribute itself. For example, how many points do we give to blood type A versus AB? 100 miles versus 1,000 miles?

3. Build Framework

Conduct sensitivity analysis

A sensitivity analysis is an analysis used by statisticians to change a single variable slightly to measure the impact on an outcome. For continuous distribution, a sensitivity tool will be used to evaluate continuous distribution of kidney and pancreas. For example, if a change is made to the weight of any attribute, the new match run will be shown as the outcome. The sensitivity analysis tool has been built to include the attributes for lung and will be updated to include both kidney and pancreas organ types for analysis.

Develop the composite score

The composite score will be a combination of the decided weights and rating scales.

4. Modeling and analysis

The Scientific Registry of Transplant Recipients (SRTR) will take proposed allocation policies and model them to determine the impact on candidates. These results will be produced in a report to help identify any potential unintended consequences or harmful outcomes for these example groups. These results will estimate the benefit of the new proposal and inform any needed improvements. The modeling request for the SRTR is expected to be submitted in 2022.

  • SRTR modeling results – expected spring 2022

5. Public comment on policy proposal

Considering community input, modeling and analysis, and committee project work, propose a new composite score as a policy proposal for public comment.

  • Continuous distribution of kidney and pancreas proposal – expected summer 2022 public comment

6. Board approval

The Board of Directors will review the proposal, OPTN and SRTR materials, and public comments, and consider the proposal in light of the requirements of the OPTN final rule. If the Board of Directors approves the proposal with the new framework, plans for implementation will begin.

  • Board briefing paper – expected winter 2022

7. Implementation

Implementation of the policy for kidney and pancreas allocation is projected to take approximately 12 months due to the range of changes, required education to the community, and expected impact.

  • Policy notice – expected 2023