Skip to main content

HHS and HRSA website links

Addressing Medically Urgent Candidates in the New Kidney Allocation System

In late 2020, donation service area (DSA) and region will be removed from kidney allocation policy and replaced with a 250 nautical mile (NM) circle and a system of proximity points.

Simultaneous to that implementation, an additional policy will go into effect to address medically urgent kidney candidates in the new system.

Toolkit sectionsToolkit

Background

At its December 2019 meeting, the OPTN Board of Directors approved a policy to remove DSA, and region from kidney and pancreas allocation. This change will impact existing medical urgency policies by eliminating Policy 8.2.a: Exceptions Due to Medical Urgency.

To address this, the OPTN Board of Directors approved an additional policy at its June 2020 meeting that provides a new definition of medical urgency and also ensures medically urgent candidates receive allocation priority in the newly approved framework.

Policy

Summary of policy changes

  • This policy creates a Medically Urgent classification within all kidney allocation tables.
  • The classification creates priority for candidates at imminent risk of death due to an inability, or anticipated inability, to accept dialysis treatment for renal failure.
  • In order to be placed into the new classification, a candidate must meet medical eligibility criteria (as defined in the policy) that indicates imminent or complete loss of dialysis access.
  • The location of the Medically Urgent classification varies in priority across each of the four kidney donor profile index, or KDPI, sequences in allocation policy. See table below for details.
    Sequence A
    KDPI 0-20%
    Sequence B
    KDPI 20-34%
    100% Highly Sensitized
    Inside Circle Prior Living Donor
    Inside Circle Pediatrics
    Medically urgent sorted above non-medically urgent
    Inside Circle Medically UrgentProposed medical urgency classification
    98%-99% Highly Sensitized
    0-ABDRmm
    Inside Circle Top 20% EPTS
    0-ABDRmm (ALL)
    Inside Circle (All)
    National Pediatrics
    National (Top 20%)
    National (All)
    100% Highly Sensitized
    Inside Circle Prior Living Donor
    Inside Circle Pediatrics
    Medically urgent sorted above non-medically urgent
    Inside Circle Medically UrgentProposed medical urgency classification
    98%-99% Highly Sensitized
    0-ABDRmm
    Inside Circle Safety Net
    Inside Circle (All)
    National (All)
    Inside Circle (dual)
    National (dual)
    Sequence C
    KDPI 35-85%
    Sequence D
    KDPI 86-100%
    100% Highly Sensitized
    Inside Circle Prior Living Donor
    Medically urgent sorted above non-medically urgent
    Inside Circle Medically UrgentProposed medical urgency classification
    98%-99% Highly Sensitized
    0-ABDRmm
    Inside Circle Safety Net
    Inside Circle (All)
    National (All)
    Inside Circle (dual)
    National (dual)
    100% Highly SensitizedMedically urgent sorted above non-medically urgent
    Inside Circle Medically UrgentProposed medical urgency classification
    98%-99% Highly Sensitized
    0-ABDRmm
    Inside Circle Safety Net
    Inside Circle
    Inside Circle (dual)
    National
    National (dual)

    Medically urgent sorted above non-medically urgent

    Proposed medical urgency classification

    Classification below proposed medical urgency classification

    Sequence A
    KDPI 0-20%
    Sequence B
    KDPI 20-34%
    Sequence C
    KDPI 35-85%
    Sequence D
    KDPI 86-100%
    100% Highly Sensitized
    Inside Circle Prior Living Donor
    Inside Circle Pediatrics
    Medically urgent sorted above non-medically urgent
    Inside Circle Medically UrgentProposed medical urgency classification
    98%-99% Highly Sensitized
    0-ABDRmm
    Inside Circle Top 20% EPTS
    0-ABDRmm (ALL)
    Inside Circle (All)
    National Pediatrics
    National (Top 20%)
    National (All)
    100% Highly Sensitized
    Inside Circle Prior Living Donor
    Inside Circle Pediatrics
    Medically urgent sorted above non-medically urgent
    Inside Circle Medically UrgentProposed medical urgency classification
    98%-99% Highly Sensitized
    0-ABDRmm
    Inside Circle Safety Net
    Inside Circle (All)
    National (All)
    Inside Circle (dual)
    National (dual)
    100% Highly Sensitized
    Inside Circle Prior Living Donor
    Medically urgent sorted above non-medically urgent
    Inside Circle Medically UrgentProposed medical urgency classification
    98%-99% Highly Sensitized
    0-ABDRmm
    Inside Circle Safety Net
    Inside Circle (All)
    National (All)
    Inside Circle (dual)
    National (dual)
    100% Highly SensitizedMedically urgent sorted above non-medically urgent
    Inside Circle Medically UrgentProposed medical urgency classification
    98%-99% Highly Sensitized
    0-ABDRmm
    Inside Circle Safety Net
    Inside Circle
    Inside Circle (dual)
    National
    National (dual)

    Medically urgent sorted above non-medically urgent

    Proposed medical urgency classification

    Classification below proposed medical urgency classification

  • A candidate’s status as Medically Urgent as defined in new policy requires members to submit supporting documentation to the OPTN.
  • Find information about post-implementation monitoring below.
  • Find details about all changes to medical urgency classifications in the policy notice below.

Policy documents

Post-implementation monitoring

The proposed language will not change the current routine monitoring of OPTN members. All policy requirements and data entered in UNetSM may be subject to review by the OPTN contractor, and members are required to provide documentation as requested.

OPTN staff will monitor and compile cases utilizing the medical urgency status. On a quarterly basis, the Kidney Transplantation Committee will review all uses of the medical urgency classification and priority status. The MPSC will review all relevant information to determine if a policy noncompliance has occurred and what type of action, if any, is warranted.

FAQs & resources

Instruction

  • Professional education resources are in development for this policy implementation—check back for more information as it becomes available.

Frequently asked questions

  • Additional resources are in development for this policy implementation—check back for more information as it becomes available.

Patient resources

  • Patient resources are in development for this policy implementation—check back for more information as it becomes available.

Related Toolkits