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Continuous Distribution of Kidneys and Pancreata Update

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Background

This paper builds upon the Kidney Transplantation and Pancreas Transplantation Committees’ 2021 concept paper and 2022 request for feedback on the continuous distribution projects. This update provides an overview of the most recent discussions and decisions regarding attributes, rating scales, public input, and the initial modeling request. Finally, this paper provides the next steps for the continuous distribution of kidneys and pancreata project.

Click the link for a closer look at Continuous Distribution: https://optn.transplant.hrsa.gov/policies-bylaws/a-closer-look/continuous-distribution/

Supporting media

Presentation

View presentation

Project Progress

  • The Kidney and Pancreas Transplantation Committees formed a joint workgroup to conduct their continuous distribution projects simultaneously
  • The Kidney-Pancreas Continuous Distribution Workgroup worked to identify goals, key attributes related to kidney and pancreas transplantation, and assign preliminary values to the identified attributes for the modeling request
  • Attributes related to a patient’s overall score include: medical urgency, expected post-transplant outcome, candidate biology, patient access and efficiency of organ placement
  • A higher score puts a patient closer to the top of a match run and more likely to receive an organ transplant

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
  • Establish 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 projects. Public Comment feedback will help the Kidney and Pancreas Transplantation Committees develop a future policy proposal.

Terms to know

  • Attribute: Attributes are criteria we use 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: A 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.
  • Rating Scale: A rating scale describes how much preference is given to candidates within each attribute.
  • Weights: 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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Provide feedback

eye iconComments

Harvey Solomon | 08/11/2022

I submit that distance is not the critical parameter but rather estimated CIT. Kidneys are transported either by ground or commercial flights.. Incorporating estimated CIT would contribute to better post-transplant outcomes and reduce discards.

James Sharrock | 08/11/2022

I’m watching the presentation on this project at the Region 4 meeting. As I do every chance I get, I encourage the Kidney and Pancreas Committees, and all committees working on continuous distribution projects to abandon the the term AHP and the phrase it stands for and replace it with “values exercise” or a similar term. Neither transplant professionals, not patients, nor the general public understand what AHP means. We are trying to determine what community values are with respect the the priorities of the identified attributes. Let’s say that in our presentations and discussions.