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Members have indicated current policy is ambiguous, out of date, and does not enable timely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://optn.transplant.hrsa.gov/data/. 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.