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Policy changes to kidney and pancreas allocation to implement Dec. 15

Published on: Tuesday, October 20, 2020

On Dec. 15, 2020, the Organ Procurement and Transplantation Network will implement policies to remove donation service area (DSA) and OPTN region from kidney and pancreas allocation. At implementation, DSA and region will be replaced with a 250 nautical mile (NM) fixed circle.

These changes to kidney and pancreas allocation were developed as a result of the OPTN Board of Directors’ 2018 directive that organ-specific committees remove DSA and region from allocation policies to align with the OPTN Final Rule. One of the requirements of the Final Rule is that policies “shall not be based on the candidate’s place of residence or place of listing, except to the extent required” by other requirements of the Rule.

Statistical simulation modeling projects that the new kidney and pancreas policies will improve transplant access for key groups of transplant candidates, including children, women, ethnic minorities and highly-sensitized candidates.

Two phases of implementation for new medical urgency requirements for kidney candidates

In order to provide a consistent definition of medical urgency and to ensure medically urgent kidney candidates receive allocation priority in the new system, a new policy creates newly defined medical urgency classifications within all kidney allocation sequences. More details, including a table of what this means for Sequences A-D, may be found on the policy toolkit page

There will be two phases of implementation for this policy: 

  • Phase I is a transition period that begins Dec. 1, two weeks (14 days) prior to the policy going live on Dec. 15. Transplant programs may enter data early but during Phase I candidates will not accrue time at medically urgent status or receive offers in that classification.
  • Phase II begins Dec. 15, the day the policy is implemented. At that time, “Medically Urgent” will be an active status in the dropdown menu.

Professional education

The following online educational modules are available on UNOS Connect:

  • KID111Modifications to Released Kidney and Pancreas Allocation
  • KID112Removing DSA and Region from Kidney and Pancreas Allocation
  • KID113Medical Urgency Data Collection Period (previously Phase 1)
  • KID114Medically Urgent Status for Adult and Pediatric Candidates (previously Phase 2)

Policy toolkits

More information about the changes involved with these policies can be found in the Professional Education section of the OPTN website.

These toolkit pages will be updated regularly with resources as they are developed, including FAQs for professionals.

OPOs may preview the new match lists in a test site
OPOs will have the opportunity to log into a test version of the UNet℠ system to preview the new kidney and kidney-pancreas match lists as well as the new released kidney match type. The test site will be available from Monday, Nov. 2 to Friday, Nov. 13 and will be populated with blinded candidate data. If you are interested in participating in this opportunity, please email the IT project lead, Lauren Motley ( for more details. The deadline to request to submit your OPO for participation is Oct. 26. 

Questions? Email