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Two new kidney policy monitoring reports available

Published on: Wednesday, September 18, 2024

Two new data monitoring reports evaluate key measures of two related kidney policies that recently went into effect. The first policy, which was implemented on September 6, 2022, aimed to standardize biopsy practices by establishing minimum donor criteria for when an organ procurement organization (OPO) must order a kidney biopsy. These changes were projected to streamline communication between OPOs and transplant hospitals and improve kidney allocation efficiency.

The second policy, which was implemented on September 14, 2023, aimed to standardize the data  that must be reported by transplant programs when a kidney procurement biopsy is performed. These changes were projected to result in better information sharing around the results of kidney biopsies, which would lead to more informed decision-making through the offer acceptance process.

Establish minimum kidney donor criteria to require biopsy

The most recent monitoring report presents one year of post-implementation data. In the post-policy era, there was a 13.29 percent increase (14,368) in the number of adult deceased kidney donors recovered compared to the pre-policy era (12,682).1

Additional key points include:

  • The percentage of donors being biopsied stayed similar between the pre and post-policy era (63.85 percent pre-policy vs. 63.22 percent post-policy)
  • The non-use rate of kidneys overall increased by one and a half percent (27.23 percent in the pre policy era vs. 28.72 percent in the post-policy era)

The report did not note a substantial increase in the percentage of donors being biopsied after this policy change; however, there were small shifts in the types of donors that are being biopsied. While it appears the non-use rate for kidneys is increasing overall, there have been shifts in the type of donors being recovered as well as being biopsied, suggesting there is not sufficient evidence to indicate use of biopsies alone has increased non-use rates.

Standardize kidney biopsy reporting and data collection

The most recent monitoring report presents six months of post-implementation data. In the post policy era, there was an increase in the number and percentage of kidneys that were biopsied (58.72 percent pre-policy vs. 64.61 percent post-policy).2

Additional findings include:

  • The wedge biopsy was the most common type of biopsy performed in both the pre- and post-policy eras
  • Based on new data fields added upon policy implementation:
    • Frozen section was the most common tissue preparation technique
    • The majority of biopsied kidneys did not report findings of vascular disease, arteriolar hyalinosis, cortical necrosis, or fibrin thrombi in the post-policy era

Continued monitoring and looking ahead

Both reports were presented to the OPTN Kidney Transplantation Committee at its August 26, 2024 meeting. The Committee will continue to monitor the policies to understand whether the changes are meeting the intended goals and to determine if they are resulting in unintended consequences. The next planned monitoring reports will be released at:

Additional OPTN kidney policy monitoring reports can be found on the Kidney & pancreas professionals page on the OPTN website.

1 Policy eras were defined as the following, so each era had the same amount of days:

  • Pre-policy: September 06, 2021 to September 05, 2022
  • Post-policy: September 06, 2022 to September 05, 2023

2 Policy eras were defined as the following:

  • Pre-policy: March 18, 2023 to September 13, 2023
  • Post-policy: September 14, 2023 to March 12, 2024