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Continuous Distribution of Kidneys and Pancreata Committee Update

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Background

This paper builds upon the Kidney Transplantation and Pancreas Transplantation Committees’ Fall 2021 Continuous Distribution of Kidneys and Pancreata Concept Paper, Winter 2022 Continuous Distribution of Kidneys and Pancreata Request for Feedback, and Fall 2022 Continuous Distribution of Kidneys and Pancreata Committee Update. This update provides an overview of the most recent discussions, the initial modeling request results, and outlines next steps for the continuous distribution of kidneys and pancreata projects.

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Presentation

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Project update

  • Since September 2020, the Kidney and Pancreas Transplantation Committees have been developing their continuous distribution project simultaneously
  • The Kidney and Pancreas Committees have worked to identify goals, key attributes related to kidney and pancreas transplantation, and assign preliminary values to the identified attributes for the first modeling request
  • Attributes related to a patient’s overall score are included in the following categories: medical urgency, expected post-transplant outcome, candidate biology, patient access, and efficiency of organ placement
  • There are multiple workgroups focusing on key areas of the project, including the creation of kidney and pancreas review boards
  • The Committees are reviewing the results from the first modeling request from the Scientific Registry of Transplant Recipients (SRTR), and are working to submit a second modeling request in early 2023
  • The OPTN will consult with SRTR and other external researchers to help narrow the number of acceptable policy options for the Committees to consider for the second modeling request
  • The Committees will continue to update the community on this project’s progress

Project goals

  • Provides a more equitable approach to matching kidneys and pancreas candidates and donors
  • Removes hard boundaries between classifications that prevent kidney and pancreas candidates from being prioritized further on the match run
  • Considers multiple patient attributes simultaneously through a composite allocation score instead of within categories
  • Establishes a system that is flexible enough to work for each organ type
  • Having a uniform system will make future policy changes faster

Anticipated impact

  • What it's expected to do
    • Prioritize candidates in a more flexible manner
    • Allow the transplant community to see how much weight is placed on each attribute
    • Improve equity in access to organ transplantation
  • What it won't do
    • This paper is not a proposed policy change, but is an update on the project
    • Public Comment feedback will help the Kidney and Pancreas Transplantation Committees develop a future policy proposal

Terms to know

  • Attribute: criteria used to classify then sort and prioritize candidates. For example, in kidney allocation, criteria include medical urgency, blood type compatibility, HLA matching, and others.
  • Composite Allocation Score: combines points from multiple attributes together. This concept paper proposes the use of composite allocation scores in a points-based framework.
  • Match run: The list of potential recipients printed by the OPO or Organ Center for each organ recovered for the purposes transplantation from each donor.
  • Modeling: Calculations the Scientific Registry of Transplant Recipients (SRTR) uses to create model predictions on the different attributes and their effect on organ allocation.
  • Organ Allocation Simulator (OASIM): The name for SRTR’s modeling for the continuous distribution allocation framework.
  • Rating Scale: describes how much preference is given to candidates within each attribute.
  • Weights: reflect the relative importance or priority of each attribute toward our overall goal of organ allocation. Combined with the ratings scale and each candidate’s information, this results in an overall composite score for prioritizing candidates.

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Read the full proposal

Provide feedback

eye iconComments

Steven Weitzen | 01/29/2023

I support the concept

Adam Frank | 01/23/2023

I hope to influence the committee working on this, to appropriately prioritize utility in deceased donor kidney transplantation. Pediatric candidates and adult candidates with superior estimated post transplant survival scores (EPTS<=20%) will have the most life years gained with a high quality deceased donor kidney transplant. Personally, I have not seen this emphasized enough with what has been presented with this project/update.