Executive summary

When the OPTN/UNOS Board of Directors approved the OPTN Strategic Plan in June 2015, they chose increasing the number of transplants as a high priority. The Membership and Professional Standards Committee (MPSC) has heard from the transplant community that the current post-transplant outcome review process creates disincentives for programs to transplant higher risk kidneys into patients for concern that the program will come under review if the transplants are not successful. While current risk-adjustment models appear to adequately adjust for the increased risk associated with use of higher risk kidneys, the perception remains. Data suggests that potentially hundreds of transplantable kidneys from higher risk donors are being discarded each year. Further research suggests that donor kidneys with similar characteristics to many of those discarded kidneys have been successfully used for transplant and may provide a better survival rate and quality of life than remaining on the waiting list for some patients.

In order to address this perceived disincentive, the MPSC is proposing an operational rule that would modify the current method for identifying kidney programs for outcomes review. The MPSC expects that this change would help eliminate concern that a kidney program would be identified for post-transplant outcomes review by the MPSC based on its performance in transplants using higher risk donor kidneys for higher risk recipients. Specifically, the MPSC would only make an inquiry to a kidney transplant program if the program falls outside the threshold for review of kidney graft or patient survival using all kidney transplants currently included in the analysis, and if they fall outside the threshold in an analysis of kidney transplants excluding higher risk transplants. Higher risk transplants would include any kidney transplant in a recipient with an estimated post-transplant survival (EPTS) score > 80 using a kidney from a donor with a KDPI ≥ 85. This two-step review process will avoid penalizing those kidney programs that are currently having successful outcomes with higher risk kidney transplants.

Read the full proposal. (PDF - 421 K)

Learn more about a related proposal.