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One-year monitoring report shows increase in kidney transplants following policy changes

Published on: Friday, July 1, 2022

A new data monitoring report contains key measures of the updated kidney distribution system, which was implemented March 15, 2021 by the Organ Procurement and Transplantation Network (OPTN). The new system removed donation service area (DSA) and OPTN region from kidney allocation and replaced them with a 250 nautical mile circle around the donor hospital. These changes were projected to increase equity, and earlier monitoring reports at three months and six months post-implementation showed increases in transplants among a number of key populations.

This most recent monitoring report presents one full year of post-implementation data. The post-policy era captured in the report experienced a 16 percent increase in overall transplant rates after the removal of DSA and region. Transplant rates increased significantly for several key populations, including:

  • 23 percent for Black candidates
  • 29 percent for Hispanic candidates
  • 20 percent for Asian candidates
  • 36 percent for candidates with more than three years of dialysis time at listing
  • 63 percent for pediatric candidates
  • 78 percent for highly-sensitized candidates with of 80-97% CPRA

The report was presented to the OPTN Kidney Transplantation Committee on June 24. The OPTN monitors policies to understand whether the changes are meeting the intended goals, and to determine if they are resulting in unintended consequences. The committee will continue to monitor these policies as data is submitted, and subsequent monitoring reports will be posted on an ongoing basis.


The changes to kidney allocation resulted from the Health Resources and Services Administration (HRSA) 2018 directive that organ-specific committees remove DSA and region from allocation policies to align with the OPTN Final Rule. The Final Rule requires that policies “shall not be based on the candidate’s place of residence or place of listing, except to the extent required” by the other requirements of the Rule.

Read the 2019 public comment on the proposal to eliminate the use of DSA and region in kidney allocation, then learn more about the OPTN policy development process.

The future state of kidney allocation

In 2019, the OPTN began work to adopt a single distribution framework that could be adapted to all organ types. This approach, continuous distribution, is a points-based system predicted to increase equity among potential recipients. Lung was the first organ type to adopt continuous distribution, and kidney and pancreas are currently moving through a series of steps as the framework is developed for their organ types.

*Updated July 5, 2022