By the conclusion of 2016, a record-setting 12,245 deceased donor kidneys transplants were performed nationwide.¹ However, there were still 98,962 candidates waiting for a kidney transplant.² One strategy to increase the number of kidney transplants is to reduce the number of discards of high Kidney Donor Profile Index (KDPI) kidneys through double kidney transplantation. The OPTN/UNOS Kidney Transplantation Committee (“the Committee”) is proposing amendments to OPTN policy to improve dual kidney allocation. 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 Amending current OPTN policy and enhancing programming could increase usage of high KDPI kidneys that are currently at increased risk for discard.

Members say that current policy is ambiguous, out-of-date, and does not enable them to identify and allocate dual kidneys in a timely manner. As a result, dual kidneys are often offered only after the wait list has been exhausted, leading to longer cold ischemia. Transplant programs, especially those with high dual transplantation volume, say that they would prefer to receive dual kidney offers earlier (ideally before organ recovery), to allow time for logistical planning and to minimize cold ischemia. Likewise, OPOs tell us that they favor pre-recovery criteria to facilitate allocation more efficiently.

The Committee distributed a concept paper during the spring 2017 public comment period in order to seek public input on three proposed concepts that aim to address the above problems. This initial round of public comment revealed support for a modification to the allocation tables that incorporate dual kidney allocation to centers that have opted in to receive these offers. The Committee now seeks additional community feedback on the selected policy solution.

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.