Kidney transplantation is the preferred treatment for end stage renal disease (ESRD), yet demand for kidneys far exceeds supply. One strategy to increase the donor pool is to utilize kidneys from small pediatric donors. However, centers may be reluctant to transplant single kidneys from small donors due to technical challenges, inferior function, and poor outcomes.

To mitigate the complications associated with transplanting kidneys from small pediatric donors singly, both kidneys, including the vena cava and aorta, can be transplanted en bloc into a single recipient. However, there are currently several challenges to allocating en bloc kidneys:

• There is currently no OPTN policy regarding how to allocate en bloc kidneys
• DonorNet^® overestimates the KDPI score for en bloc kidneys, which has the potential to screen medically suitable candidates off the match run and other programming limitations make allocating kidneys en bloc a challenge

The proposed policy resolves the problems outlined above by providing explicit direction to organ procurement organizations (OPOs) on when to allocate en bloc kidneys. The policy includes criteria regarding the type of kidneys that can be allocated en bloc and mandates that centers must indicate in DonorNet® that they accept en bloc kidneys, thus expediting placement of en bloc kidneys to centers that will transplant them. In addition, the Committee proposes omitting the KDPI score for en bloc kidney offers to prevent potentially eligible candidates from being screened off the match run for kidneys from high KDPI donors.

This proposal aligns with three OPTN strategic goals. First, it should increase the number of transplants by utilizing kidneys previously left unrecovered or discarded. Second, it will improve outcomes for waitlisted kidney candidates and transplant recipients as studies indicate when kidneys from a small pediatric donor are transplanted into a recipient en bloc versus singly, they confer comparable to superior outcomes. In addition, accepting kidneys en bloc may shorten a pediatric candidate’s time on the waitlist, conferring not only a survival advantage, but several other additional benefits. Finally, this proposal should increase efficiency in management of the OPTN as OPOs should no longer have to contact the Organ Center for guidance or assistance in allocating en bloc kidneys.