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​​Concepts for Modifying Multi-Organ Policies​

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Current policy

Starting with the concept paper, Identifying Priority Shares in Kidney-Multi-Organ Allocation, in Winter 2023, the Ad Hoc Multi-Organ Transplantation Committee has been working on a project to improve equity in access to transplant for kidney-alone candidates and kidney multi-organ (MOT) candidates. Following the public comment period for the concept paper, the Committee has been reviewing the public comment feedback, evaluating data, and is now requesting additional input from the community on prioritization of kidney-alone candidates compared to kidney MOT candidates. The Committee is also asking the community for input on potential future guidance to help organ procurement organizations (OPOs) allocate multi-organ combinations in a more efficient way.

Supporting media

View presentation PDF link

Requested feedback

  • Kidney Alone Candidates compared to Kidney MOT Candidates
    • Do patients and donor family members support efforts to improve access to transplant for kidney alone candidates, even if it means that kidney MOT candidates may need to wait longer for a suitable donor?
    • Should kidney-pancreas (KP) candidates be considered multi-organ candidates?
    • When both kidneys are available from a donor with a Kidney Donor Profile Index (KDPI) between 0-34 percent:
      • Should one kidney be allocated to an MOT candidate (including KP), and the second kidney allocated to a kidney alone candidate?
      • Should one kidney be allocated to an MOT candidate, and the second kidney to either a KP candidate or kidney alone candidate?
      • What are the potential impacts to KP and pediatric candidates?
    • How should MOT candidates be prioritized when there is only one kidney available?
  • Policy Guidance for OPOs
    • Should policy direct the order in which OPOs allocate organs?
      • If so, how should expected waitlist mortality or graft survival be incorporated into the prioritization of candidates across different organ match runs?
    • What additional policy or system considerations would OPOs need in order to follow a match run order?

Anticipated impact

  • What it's expected to do
    • Improve equity in access to transplantation between kidney alone candidates and kidney multi-organ candidates.
    • Improve allocation efficiency when allocating multiple organ types from one donor.
  • What it won't do
    • This will not change current OPTN Policy at this time. The committee will use the feedback received during public comment to help develop a future policy proposal.

Terms to know

  • Kidney Alone Candidate: A person registered on the kidney transplant waiting list and is not added to any other organ transplant waiting lists.
  • Kidney Multi-Organ Candidate: A person registered on the kidney transplant waiting list and is also added to one or more organ transplant waiting lists.
  • Kidney Donor Profile Index (KDPI): Kidneys from deceased donors are classified according to the Kidney Donor Profile Index (KDPI). The KDPI score is derived directly from the Kidney Donor Risk Index (KDRI) score. The KDPI is the percentage of donors in the reference population that have a KDRI less than or equal to this donor's KDRI.

Click here to search the OPTN glossary


Read the full proposal (PDF)

Provide feedback

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OPTN Organ Procurement Organization Committee | 02/20/2024

The OPTN Organ Procurement Organization (OPO) Committee thanks the Multi-Organ Transplantation Committee for their work on this proposal and the opportunity to provide feedback. The Committee agreed that the OPTN should provide guidance in determining which organs and organ combinations should receive priority. Several members shared their experiences and challenges in the allocation of multi-organs, particularly with extra-renal and abdominal multi-organ allocation. Members noted that OPTN guidance or policy would reduce the burden on OPOs to make clinical priority determinations.

In considering a requirement for KDPI 0-34 percent donors to have only one organ allocated to a multi-organ candidate, with the other allocated to a kidney-alone candidate, the Committee expressed concerns that this policy could potentially disadvantage certain multi-organ groups. The Committee also specifically noted that this policy could have a greater impact on OPOs in their ability to allocate pancreata, particularly as isolated pancreas transplantation is rare, and most pancreas candidates are also listed for a kidney.

Déboralis Ramos | 01/31/2024

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