Eliminate the use of DSA and Region in kidney allocation policy
Sponsoring Committee: Kidney Transplantation
Strategic Goal: Provide equity in access to transplants
Policy Notice 12/2019 (PDF - 1,449 K)
Read the Board Briefing Paper (11/2019)
Read the proposal (PDF; 8/2019)
View kidney allocation proposal maps (8/2019)
Kidney and Pancreas Distribution Modeling: Analysis at a Glance (8/2019)
DSA data table updates (8/2019)
Contact: Tina Rhoades
At a glance
You may be interested in this proposal if
- You or your loved one needs a kidney transplant
- You are a healthcare professional who cares for end stage renal disease patients
- You work for a kidney transplant program or an Organ Procurement Organization (OPO)
Here’s what we propose and why
The OPTN Kidney Transplantation Committee proposes to remove Donation Service Area (DSA) and regional boundaries used in the current system and allocate using a 500 nautical mile (NM) circle around the donor hospital. Points would be assigned based on how close the candidate’s transplant hospital is to the hospital where the organ donation takes place. This is to prevent a kidney being transported further away when there is a candidate of similar priority closer to the donor hospital. The kidney would first be allocated to all eligible candidates inside the 500 NM circle. If the organ has not been accepted by those candidates, it would then be offered to other eligible candidates.
Location should not hinder access to transplant. The goal of this proposal is to provide consistent distribution units and promote patient access to transplant.
The proposed change would also increase priority for pediatric patients and for prior living donors who now need a transplant. Aside from these changes, kidneys will still be matched with patients according to current criteria.
Why this may matter to you
The goal of this proposal is to increase equity in access for U.S. kidney transplant candidates. Some areas of the country will see an increase in kidney transplants which means other areas will experience a decrease. Some kidneys would have to travel further than they do today, in order to meet this goal. This change would result in new working relationships between OPOs and transplant centers.
Tell us what you think
- What factors should be used to select a circle size that distributes kidneys broadly and efficiently?
- Should proximity points be used inside the 500 NM circle? Should they be used outside the distribution circle? How should the assigned values be weighted in relation to other kidney allocation points?
- What priority do you think is appropriate for pediatric candidates? Should prioritization be applied inside the distribution circle? Should prioritization be applied outside the distribution circle?
- What priority do you think is appropriate for prior living donor candidates? Should prioritization be applied inside the distribution circle?
- What operational concerns should the committee consider as this policy is being prepared for OPTN board action and implementation?
- Should medical urgency criteria be defined? If so, what specific conditions would qualify? Where should the new medically urgent classification be placed within allocation tables? Should placement within allocation tables vary depending on the KDPI of the donor kidney? How should two medically urgent candidates be prioritized should two appear on the same match run?
- When import back up is granted, do you support the use of an import match run for the import OPO to reallocate the kidney? Should the match run use the same size circle as the original allocation but with increased points for proximity? Should the circle size be smaller? If so, what distance will promote the efficient reallocation of kidneys?