Pre-implementation notice: Removal of DSA and region from kidney and pancreas allocation to go into effect Dec. 15

Published on: Monday, November 16, 2020

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Implementation date:

Dec. 15, 2020

At-a-glance

On Dec. 15, the Organ Procurement and Transplantation Network will implement policies to remove donation service area (DSA) and OPTN region from kidney and pancreas allocation. In the new system, deceased donor kidney and pancreas offers (except for those involving very rare donor and recipient combinations nationwide) will be offered first to candidates listed at transplant hospitals within 250 nautical miles (NM) of the donor hospital. Offers not accepted for any of these candidates will then be made for candidates beyond the 250 NM distance.

Other changes will simultaneously go into effect Dec. 15 regarding allocation of kidneys and pancreata from Alaska and addressing medical urgency for kidney patients in the new kidney allocation system. Finally, there will be substantive changes to how released kidneys, pancreata, kidney-pancreas and islets are allocated if the original intended candidate is not able to be transplanted. An FAQ document will be available soon. Find details about professional education available on UNOS Connect below. A recording of a webinar for patients and their caregivers that explains the changes is now available.

Summary of changes

Removal of DSA and region from kidney and pancreas allocation.

These policy changes remove DSA and region from kidney and pancreas allocation. The policy replaces DSA and region with a 250 NM fixed circle and adds proximity points to a candidate’s total allocation score. The policy also adds increased priority for living donor and pediatric candidates in allocation. Refer to the kidney policy toolkit page and the pancreas policy toolkit page for details.

Candidates listed inside the 250 NM circle can receive a maximum of two proximity points. Candidates listed outside the circle can receive a maximum of four proximity points. Candidates registered at transplant hospitals farther than 2500 NM from a donor will not receive any proximity points. This visual aid shows an example of how proximity points impact allocation for candidates inside and outside the circle.

Kidney transplant professionals should reference Table 8-1 in the policy notice to eliminate DSA from kidney allocation for more information about how proximity points are calculated for kidney candidates.
Pancreas transplant professionals should reference Table 11-1 in the policy notice to eliminate DSA from pancreas allocation for more information about how proximity points are calculated for pancreas, kidney-pancreas and islets candidates.

Addressing medically urgent candidates in the new kidney allocation system

The policy to eliminate DSA and region from kidney allocation will impact existing medical urgency policies by eliminating Policy 8.2.a: Exceptions Due to Medical Urgency. The policy notice provides details on the new medical urgency classifications within all kidney allocation sequences. This policy change was approved in order to provide a consistent definition of medical urgency and also ensure medically urgent candidates receive allocation priority in the new system. Find a summary of policy changes and policy documents on the policy toolkit page.

This policy will be implemented in two phases. Phase I of implementation will begin Dec. 1, allowing transplant programs to pre-enter medically urgent qualifying information for their candidates so they may receive the new status and priority immediately at Phase II implementation. Read more about Phase I implementation and what kidney professionals will need to do to update their candidate’s status.

Phase II implementation will occur on Dec. 15, when DSA and region are eliminated from kidney and pancreas allocation. At this time, candidates who meet the new definition of medical urgency and have pre-entered qualifying data will be converted to the new status and will receive priority under the revised policy.

Modifications to released kidney and pancreas allocation

The removal of DSA and region from kidney and pancreas allocation requires the modification of policies related to the reallocation of released kidneys and pancreata. The new released organ allocation policies address the reallocation of kidney, kidney-pancreas, pancreas, and islets in situations in which an organ allocated to an original intended recipient is unable to be transplanted in that recipient.

The major change will be that the host OPO will maintain responsibility for any necessary continued allocation after an organ has been declined. For kidneys, this means either using the original match run or a new match run with a 250NM circle around the original accepting transplant hospital. The allocation of released kidneys will no longer be done at the importing OPO or DSA level. Read the policy notice for more information about host OPO processes for released kidney, pancreas, kidney-pancreas and islets. Find a summary of changes and guidance on the policy toolkit page.

Distribution of kidney and pancreata from Alaska

This policy adds Policy 8.7.D: Location of Donor Hospitals and Policy 11.8.A: Location of Donor Hospitals to the kidney and pancreas policies respectively. The change establishes the Seattle-Tacoma airport (Sea-Tac) as the administrative center for the 250 NM circle of allocation for kidneys and pancreata procured from Alaska. Read the police notice for more details.

Professional education resources

An FAQ is in development. Additional resources and trainings for professionals at OPOs, transplant hospitals and histocompatibility labs are available on UNOS Connect.

KID111: Modifications to Released Kidney and Pancreas Allocation
KID112 - Removing DSA and Region from Kidney and Pancreas Allocation
KID113 - Medical Urgency Data Collection Period (previously Phase 1)
KID114 - Medically Urgent Status for Adult and Pediatric Candidates (previously Phase 2)

Find all policy notices and other guidance in the policy toolkits in the Professional Education section of the OPTN website:

Do you have questions about the implementation?

If you have questions related to the implementation, contact UNOS Customer Service at unethelpdesk@unos.org, or call 800-978-4334 from 8 a.m. to 7 p.m. EST.

For policy-related questions, email member.questions@unos.org.

The Organ Center is available around the clock and can be reached at 800-292-9537.