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Dual and en bloc kidney allocation changes

Audience

Kidney transplant program and OPO staff

At-a-glance

We will implement policy and system changes for dual kidney and en bloc kidney allocation in two phases.

  • 7/29/2019: Phase 1 – WaitlistSM
  • 9/5/2019: Phase 2 – Policy and DonorNet®

Instructional offerings are available through UNOS Connect

  • Improving Dual and En bloc Kidney Allocation Policy (KID110) (15 minutes)
  • Waitlist functionality: Improving Dual and En bloc Kidney Allocation (SYS142) (5 minutes)
  • DonorNet functionality: Improving en bloc and dual kidney allocation (available 8/26/2019)

Frequently asked questions (FAQs) for Phases 1 and 2 are below. 

More details

The OPTN Board of Directors approved changes in December 2017. The Kidney Transplantation Committee sponsored two separate policy proposals to increase transplants, improve patient outcomes and increase efficiency.

Dual kidney allocation: Revised policy identifies which kidneys must be offered as dual kidneys and indicates when OPOs must make dual kidney offers. To increase efficiency in placing dual kidneys, the policy also requires kidney transplant programs to indicate in UNet which candidates are willing to accept dual kidney offers.

Transplant hospitals that wish to accept dual kidney offers will need to opt-in after we implement changes to Waitlist in phase 1.

En bloc kidney allocation: New policy adds weight as required deceased donor information. Kidneys recovered from deceased donors who weigh less than 18 kg must be offered together (en bloc).

Kidney programs will be required to indicate in UNet which candidates are willing to accept en bloc kidney offers.

Dual and en bloc kidney frequently asked questions

Phase 2

Can en bloc kidneys that have been split be offered in the dual classifications?

Yes, if the donor has a KDPI above 34%, they can still be offered as dual kidneys.

If en bloc kidneys are procured and then split, how do I allocate the remaining single small kidney?

The second kidney will now be allocated based on KDPI, according to released organ policy.

What if I am making a kidney offer and I no longer have both kidneys to offer as dual?

In this instance, OPOs can use the Dual Bypass button to quickly bypass all dual kidney offers.

What should I do if my second kidney becomes available again?

Should the second kidney become available again, OPOs will be able to use the roll back button to remove dual kidney bypass codes.

Why do I no longer see the “Does donor meet double kidney allocation criteria in policy:” question on the match initiation screen?

Now that dual kidney classifications have been added to the match run for Sequence C and D (KDPI > 34%), this screening question is no longer necessary. If your center opts in to receive dual kidney offers for candidates, candidates will automatically appear on the match run in dual kidney classifications if they aren’t screened off for any other reason.

Why do I no longer see the “Will your center consider pediatric en bloc kidneys?” question on KIMAC?

Now that there is a match run specifically for allocating en bloc kidneys, this screening question is no longer necessary. If your center opts in to receive en bloc kidney offers for candidates, candidates will automatically appear on the en bloc match run if they aren’t screened off for any other reason.

Phase 1

For Phase 1, what do kidney transplant programs need to do?

Kidney programs will have one month to “opt in” their waitlist candidates and review their minimum and maximum donor acceptance criteria KDPI values in order to receive dual kidney and/or en bloc offers upon release of Phase 2 on September 5, 2019. If a center and/or kidney candidate is not “opted in” upon release of Phase 2, candidates will not receive offers for en bloc or dual donor kidneys.

When did Phase 1 go into effect?

Phase 1 was effective on July 29, 2019.

How does a kidney transplant program “opt in” to receive en bloc and/or dual kidney offers?

These are three ways transplant programs can update candidate acceptance criteria in Waitlist to receive en bloc and/or dual kidney offers:

  • Waitlist Update Utility (existing candidates)
  • Listing Defaults (new candidates)
  • Individual Candidate Record

What will happen to the maximum acceptable KDPI values under kidney donor acceptance criteria for dual? 

To help ease the burden of data entry, upon implementation of Phase 1, candidates’ minimum and maximum dual KDPI values will be populated with their single KDPI minimum and maximum acceptance values, if present. Kidney transplant programs will be able to modify these values after they have been set. Dual kidney KDPI values are only used for candidates who have “opted in” to receive dual kidney offers

Will WaitlistSM reports be updated?

No new reports will be added to Waitlist. However, transplant programs can easily run a custom report to see which patients are “opted in” to receive dual and/or en bloc kidney offers in addition to the single and dual KDPI values.

Why do I no longer see “double” or “sequential” when referencing kidney in UNet?

To be in line with Policy language, references to “sequential” or “double” when referencing kidneys have been changed to “dual kidney”.

Where can I go to learn more?

There are two UNOS Connect Offerings:

  • KID110:  Improving Dual and En bloc Kidney Allocation Policy (~15 minutes)
  • SYS142:  WaitlistSM Functionality: Improving Dual and En bloc Kidney Allocation (~5 minutes)

Go to https://unosconnect.unos.org/ and sign in to access.

About UNOS Connect

  • UNet users: If you have access to UNOS Secure EnterpriseSM systems: UNet, WaitlistSM, DonorNet®, Tiedi®, KPDSM and other UNOS-developed transplant applications, your account is already set-up and there is no need for you to register. Access UNOS Connect with your UNet username and password. This will allow you full access to the site to view system training recordings, register for policy webinars and view materials.
  • Other users: The first time you visit UNOS Connect, you will need to complete a brief, online form to register for the site. After that, you will have access to a wide range of UNOS instructional offerings and materials, except system training.

Contacts

If you have questions about OPTN policy, please contact member.questions@unos.org or (844) 395-4428. For UNetSM system questions, contact UNOS customer service at unethelpdesk@unos.org or (800) 978-4334.