OPTN Board approves exclusion of race, hepatitis C status from estimate of deceased donor kidney function

Published on: Friday, June 28, 2024

Richmond, Va. - The Board of Directors of the Organ Procurement and Transplantation Network, at its meeting June 17-18, approved revisions to the Kidney Donor Profile Index (KDPI), a calculation that estimates the likely length of function of kidneys from a deceased donor according to several criteria. The action will remove two variables – whether the potential donor is African-American/Black and whether the potential donor has tested positive for the hepatitis C virus (HCV).

“The entire donation and transplant community is committed to increasing equity, and this policy change takes an important step towards reaching that goal,” said Dianne LaPointe Rudow, DNP, OPTN board president. “Kidney transplant clinicians often rely on the KDPI to inform their decision of whether to accept a kidney offer for their patient. By removing race as a factor, we expect more kidneys from Black organ donors will be accepted, particularly for Black recipients, who may be a close match based on immune system matching.”

The existing KDPI formula suggests that kidneys from donors identified as African American or Black are likely to function for a shorter amount of time than those from donors with other racial or ethnic backgrounds. Also, when the KDPI was established in deceased donor kidney allocation policy in 2014, hepatitis C was generally considered an incurable virus, and kidneys from HCV-positive donors were expected to last less time than kidneys from HCV-negative donors. The later introduction of highly successful medications to treat HCV has greatly reduced the negative effect, even if a kidney from an HCV-positive donor is transplanted into an HCV-negative recipient.

OPTN code of conduct and whistleblower policy

In a separate meeting June 12, the board approved a new code of conduct to apply to volunteers serving on the OPTN Board of Directors, as well as OPTN committees and review boards. The board also approved a policy to address processes to report and address potential wrongdoing, including protections for individuals who report such incidents.

Other actions

The board took a number of additional actions as follows, at sessions held June 12, 17, 18 and 25:

• Clarified OPTN policy requirements relating to the pronouncement of death for deceased donors
• Endorsed addition of two new data fields relating to lung donor offers as part of a series of improvements intended to promote efficiency in lung allocation
• Approved a policy modification, new clinical guidance and an updated data definition regarding the six-minute walk test used in lung allocation policy
• Added and updated requirements for patient safety contacts at transplant programs and OPOs
• Updated and added to requirements for post-transplant histocompatibility data collection
• Approved updates to liver allocation policy and National Liver Review Board guidelines and guidance to better reflect developments in transplant oncology
• Approved policy clarifications regarding organ offer acceptance in situations that may involve multi-organ offers
• Approved an OPTN strategic plan to guide initiatives from July 1, 2024, through September 30, 2027

Discussion items

At its meeting June 17-18, the board heard and discussed status updates on significant and ongoing OPTN initiatives, including:

• The work of the OPTN Expeditious Task Force and the development of rescue pathway protocols
• The status of organ allocation systems based on the continuous distribution framework
• Opportunities to enhance the number of transplants from living donors, stemming from deliberations of the OPTN Living Donor Committee