A recent journal article concludes that the OPTN kidney allocation system (KAS) is accomplishing a number of key goals, especially in regard to measures of equity and longevity matching. Yet challenges remain in terms of geographic access and organ utilization.
The study, “KAS Turns Four: The State of Deceased Donor Kidney Allocation in the U.S.,” published in OBM Transplantation, is available here in open source.
The researchers compared the number and proportions of deceased donor kidney transplants by recipient and transplant characteristics from December 2013 through September 2018 and compared relevant trends both before and after KAS implementation.
Importantly, throughout the study period the number of deceased donor kidney transplants continued to increase. This trend began prior to KAS and can’t be independently associated with the new system. It is, however, a positive finding that has remained steady over a sustained period before and after KAS’ introduction.
Soon after KAS implementation, some bolus effects were noticeable as candidates who had previously had lower transplant access received additional priority. These included very highly sensitized patients, African-American candidates and those receiving non-local offers. While these effects have generally settled back to baseline levels in recent years, those baselines remain higher than they were prior to KAS.
In general, KAS has improved the equity of candidates’ access to kidney transplantation, notably by ethnicity and immune sensitization. However, the geographic location of the transplant hospital (assessed by the hospital’s donation service area, or DSA) remains a primary driver in variation to transplant rates. In addition, utilization of available deceased donor kidneys has remained largely unchanged overall, although since 2016 there has been a slight decrease in declines of offers for KDPI values between 35 and 85 percent.
A number of efforts are underway to address areas of potential improvement. These include the ongoing work to balance geographic access to transplantation, as well as collaborative efforts to learn and share effective practices for utilization of higher KDPI kidneys.
For more detail, consult the article:
Stewart, D.E., Wilk, A.R., Klassen, D.K. KAS Turns Four: The State of Deceased Donor Kidney Allocation in the U.S. OBM Transplantation, Vol. 3, Issue 1, 2019.