Modifications to Released Kidney and Pancreas Allocation

Proposal Overview

Status: Implemented

Sponsoring Committee: Organ Procurement Organization (OPO)

Strategic Goal: Improve waitlisted patient, living donor, and transplant recipient outcomes

Read the proposal (PDF; 01/2020)

View the Board Briefing Paper (PDF; 06/2020)

View the Policy Notice (PDF; 6/2020)

Contact: Pete Sokol

At a glance

What is current policy and why change it?

If a transplant hospital is unable to transplant a kidney or pancreas into the patient they accepted the organ for, they must contact the Organ Procurement Organization (OPO) that offered them the organ so that a new recipient can be found. That “host” OPO has the option to continue offering the organ or they can delegate that responsibility to the “importing” OPO that serves the transplant center that declined the organ. The importing OPO then runs a list of eligible candidates within their Donation Service Area (DSA) to hopefully find another recipient that is close-by.

The OPTN Board of Directors approved policy in December 2019 that removes DSA and region from OPTN kidney and pancreas allocation policy and instead uses a 250 nautical mile (NM) circle with the donor hospital at the center. Having policies for reallocation of a kidney or pancreas that are consistent with the Board-approved changes promotes efficiency and organ utilization.

What’s the proposal?

• Host OPO would have 2 options when an original recipient can’t receive intended kidney or pancreas:
  • Continue to find a new recipient.
  • Delegate responsibility to the UNOS Organ Center.

• If host OPO decides to continue to find new recipient, they can:
  • Use the original match run; or
  • Create a new match run based on the transplant hospital that originally accepted the organ.
    • Offer the organ to patients within a 250NM circle of the transplant hospital first.
    • Candidates inside the circle receive up to 2 proximity points based on how close their transplant hospital is to the center of the circle.
    • If no candidate within the circle accepts the organ it would then be offered to patients outside of the circle.
    • These candidates could receive up to 4 proximity points.

What’s the anticipated impact of this change?

• What it’s expected to do
  • Create a process for reallocation of organs from candidates who cannot be transplanted that aligns with the new kidney and pancreas allocation policies.

Themes to consider

• The circle size for reallocation.
• Should the process be the same for kidney and pancreas.
• Who should be responsible for reallocating the organ(s).

Terms you need to know

• Match run: A computerized ranking of transplant candidates for an organ being offered based upon donor and candidate medical compatibility and criteria defined in OPTN policies.
• Nautical Mile: Equal to 1.15 miles and is directly related to latitude and longitude; used in aviation.
• Proximity Points: additional points given to transplant candidates on a match run based off of the location of their transplant hospital in relation to the center of the allocation circle.  The closer to the center of the circle, the more points a candidate receives.
• Reallocation:  The process of finding the next suitable transplant candidate for an organ after it has been accepted and then declined for the original intended recipient.
• Click here to search the OPTN glossary.