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Community feedback needed on development of policy for continuous distribution of kidneys and pancreata

The Organ Procurement and Transplantation Network (OPTN) Kidney Transplantation and Pancreas Transplantation Committees have been working to develop policy for continuous distribution of kidneys and pancreata. Continuous distribution combines all matching factors into a single composite score in order to allocate deceased donor organs, and the framework is flexible enough to apply to all organ types. Each organ type will be looked at individually in order to develop a continuous distribution policy specific to that organ, and the process will involve community feedback. Lung was the first organ type to go through the continuous distribution policy development process.

The community is encouraged to share feedback related to factors involved in kidney and pancreas allocation. To collect input, special prioritization exercises informed by a multi-criteria decision-making methodology called analytic hierarchy prioritization (AHP) are now underway. The exercises are open during the current public comment cycle, which closes March 23. Patient feedback is especially important to transplant policy development, and patients are encouraged to provide their input.

In the continuous distribution framework, every candidate will receive a composite allocation score. This composite score will combine a number of factors such as the candidate’s need for a transplant and how well they match to the individual organ donor. All of the factors will be considered together, but every factor will also be weighted. Every organ type will have a specific set of attributes that will be considered. Learn more about the points-based system on the main continuous distribution resources page.

The kidney and pancreas AHP exercises are an opportunity for the community to comment on how different factors are weighted in composite scoring.

Before you participate in the AHP exercise

Learn more about continuous distribution and organ allocation goals on the continuous distribution information hub page. Resources include patient-friendly animations and recorded presentations that explain the points-based system, organ allocation goals and AHP methodology.

After you have reviewed this background material

Visit the kidney and pancreas continuous distribution page to watch presentations on factors related to kidney and pancreas allocation in the current system, and track the policy development progress. It is important to review this information before participating in the exercise.

Register for the AHP exercise

A registration link to the prioritization exercises may be found on the public comment page for the Kidney Transplantation and Pancreas Transplantation Committees’ co-sponsored request for feedback, Update on Continuous Distribution of Kidneys and Pancreata. Participants may also submit comments by email, fax, or mail. For more details, please contact the OPTN at 1-888-894-6361 or at member.questions@unos.org, 8:30 a.m. – 5:30 p.m. ET, Monday-Friday.

Making informed decisions about weighting attributes will be an important part of the continuous distribution policy development process.

More about continuous distribution

The continuous distribution framework is flexible enough to apply to all organ types because it can be tailored based on the matching factors appropriate for each organ. The framework aims to:

  • Prioritize sickest candidates first to reduce waitlist deaths
  • Improve long-term survival after transplant
  • Increase transplant opportunities for patients who are medically harder to match
  • Increase transplant opportunities for candidates with distinct characteristics, including candidates under the age of 18 or prior living donors
  • Promote the efficient management of organ placement

Using the same framework for all organs will improve organ allocation by creating consistency and transparency for the entire transplant community. To apply the framework to each organ, each organ type will be looked at individually and result in organ-specific policy. This process started with lung and is continuing with kidney and pancreas. The OPTN Board of Directors unanimously voted to adopt a policy establishing continuous distribution of lung at its December 2021 meeting, and implementation is pending.

The goals of the new continuous distribution framework are consistent with allocation requirements in the National Organ Transplant Act (NOTA) and the OPTN Final Rule. Each organ type’s final continuous distribution policy will be adopted by the OPTN Board of Directors and will comply with NOTA and the OPTN Final Rule.