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​​Refit Kidney Donor Profile Index without Race and Hepatitis C​ Virus

eye iconAt a glance

Current policy

The Kidney Donor Profile Index (KDPI) is a measure that summarizes the quality of deceased donor kidneys and assigns a score. To get the KDPI score, you must first calculate the Kidney Donor Risk Index (KDRI) which is an estimate of the risk that a kidney will fail after transplant. A lower KDPI score is associated with kidneys that will function for a longer amount of time while a higher score is associated with a shorter amount of organ function time. Currently, kidneys from African American/Black and Hepatitis C (HCV) positive deceased donors have an increased KDPI making them appear less suitable for transplant. The committee proposes refitting the KDPI calculation without race or HCV to better reflect the likelihood of graft failure for kidneys from African American/Black and HCV positive deceased donor kidneys.

Supporting media

View presentation PDF link

Proposed changes

  • Remove the race and HCV positive variables from the KDPI to better reflect the likelihood of graft failure for kidneys from African American/Black and HCV positive deceased donors

Anticipated impact

  • What it's expected to do
    • Better reflect likelihood of graft failure for kidneys from African Americans/Black and HCV positive deceased kidney donors
    • Increase equity and transparency
    • Potentially decrease the non-use of deceased donor kidneys
  • What it won't do
    • It will not change organ allocation sequence for kidney distribution

Terms to know

  • Kidney Donor Risk Index (KDRI): An estimate of the relative risk of post-transplant kidney graft failure for a given donor compared to compared to the median/reference kidney donor
  • Kidney Donor Profile Index (KDPI): A measure that combines deceased donor factors including clinical parameters and demographics to summarize the quality deceased donor kidney into a single number
  • Hepatitis C: An infection caused by a virus that attacks the liver and leads to inflammation
  • Deceased donor kidney: A kidney from someone who recently died is removed with consent of the family or from a donor
  • Graft Failure: A failure of graft function for any reason, requiring renal replacement therapy and/or re-transplantation

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Read the full proposal (PDF)

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eye iconComments

Anonymous | 02/21/2024

Anything that unnecessarily creates barriers for people in need should be resolved as soon as possible. People on the waitlist for kidneys already face long wait times while living in pain and discomfort, and it makes no sense for policies to exist that are creating more barriers between these people and the transplant they need. Discrimination and perpetuation of discriminatory practices has no place in the medical world, which should strive to serve all people the way they need to be served: with equity. If there is no scientific basis for race and HCV needing to be a factor in the calculation of the KDPI, it’s only right to remove such factors.

DARLENE COWELL | 02/18/2024

As a candidate for a donated kidney the race of a donor kidney is not an important factor. The important factor is receiving a healthy kidney to replace my failing kidney. As a dialysis patient I would never turn down a donated kidney because of race.

Anonymous | 02/18/2024

As a living, non-directed kidney donor I support the proposed initiative to adjust the current Kidney Donor Risk Index to better reflect the likelihood of organ transplant success. Focusing on individual health instead of race as a determining factor will be a step toward equity in the healthcare system. The current system, which includes the calculation of race and Hepatitis C status, results in the discarding of viable kidneys and disproportionately affects non-white patients on the waitlist.

Melissa Sanchez | 02/09/2024

On behalf of the more than 90,000 individuals on the waitlist awaiting a life-saving kidney donation, I write in strong support of OPTN’s proposal to remove race and hepatitis C status as variables when calculating the Kidney Donor Profile Index. The previous policy’s inclusion of Black race as a coefficient inaccurately scored the quality and predicted function of a kidney from a deceased organ donor to be worse than that of a non-Black organ donor. This calculation was not based in science or evidence and had the unintended effect of increasing discards of otherwise viable kidneys. Race has no place in clinical calculations, and I strongly support OPTN’s proposal to correct this injustice. I encourage OPTN to adopt this proposal and move forward with its prompt implementation.

Northwest Kidney Centers | 02/01/2024

It is astounding how long the fields of nephrology and transplantation in general have allowed the use of race to determine so many aspects of clinical evaluation and access to care, regarding kidney disease and treatment. It must be acknowledged that this is due to the inheritance of old, staunch beliefs and medical paradigms about differences among races, created in the time of medical experimentation on slaves in the U.S. These old paradigms still infect healthcare in general, but I believe that this proposal is a wonderful first step in retiring these culturally-based (not scientifically-based) paradigms. Removing race and Hep C from donor profiles is long overdue, and I am grateful and fully supportive of this move to correct a long time barrier for so many patients, and the opportunity to significantly improve access for all patients in need of transplantation. Thank you!

Peter Reese | 01/31/2024

We have carefully reviewed the OPTN proposal for revising the kidney donor risk index (KDRI). Our group comprises doctors, epidemiologists and statisticians. We completely support the MAC’s goal of removing race and hepatitis C serostatus from the KDRI.
However, we have substantial concerns about the transparency of the modeling approach. Given the lack of transparency, it is not possible for outside experts to determine whether the new models meet basic metrics of quality in terms of predictive accuracy. The best quality prediction models have high discrimination, high calibration and ideally, external validation. Reading the report, we cannot ascertain the following:

1) what recipient variables were used in the model; it appears that recipient variables were used both in the original KDPI and this revised model, although the way that recipient variables were modeled is unclear because the KDPI calculation in practice only depends on inputting donor variables;
2) discrimination performance in key demographic subgroups of donors and potentially, in recipient subgroups;
3) calibration performance, which is most transparent when presented visually, and which must be examined in key subgroups. Reporting on Brier scores alone is insufficient.
4) outcomes for the validation of discrimination and validation performance.

We strongly encourage the MAC associated analysts to supplement the report with this detailed information. Without this information, it is not possible for anyone to know if the new KDRI would help, harm or remain neutral to efficiency or equity in kidney allocation. To give a concrete example, bad calibration is quite likely to cause bad decision-making when kidneys are offered to centers. Our group would be glad to collaborate with the MAC in evaluating the work. -Peter Reese, MD PhD and Sarah Ratcliffe, PhD for the Abdominal Organ Quality Prediction Group.

Anonymous | 01/30/2024

Please do whatever can be done to make as many kidneys available as possible! I waited on dialysis for over 5 years. Along with that my transplant hospital that I had to travel5 hours to get to and stay at gave me a Hep C kidney. With just 3 months of medication everything has simply been fine and great! I waited 3 and a half years listed at a hospital that would not give Hep C kidneys and 3 and a half weeks at a hospital that would!!

Northwest Kidney Centers | 01/29/2024

On behalf of the more than 90,000 individuals on the waitlist awaiting a life-saving kidney donation, Northwest Kidney Centers writes in strong support of OPTN’s proposal to remove race and hepatitis C status as variables when calculating the Kidney Donor Profile Index. The previous policy’s inclusion of Black race as a coefficient inaccurately scored the quality and predicted function of a kidney from a deceased organ donor to be worse than that of a non-Black organ donor. This calculation was not based in science or evidence and had the unintended effect of increasing discards of otherwise viable kidneys. Race has no place in
clinical calculations, and we strongly support OPTN’s proposal to correct this injustice. We encourage OPTN to adopt this proposal and move forward with its prompt implementation.

With gratitude,
Northwest Kidney Centers Staff
https://www.nwkidney.org

National Kidney Foundation | 01/29/2024

I strongly support the National Kidney Foundation in their efforts to eliminate Race or Hep C from the listing of requirements for Transplantation.

Anonymous | 01/27/2024

As a kidney transplant recipient, I know how transplantation can change the trajectory of an individual's life. I strongly support OPTN's proposal to remove race and hepatitis C status as variable when calculating the Kidney Donor Profile Index.

Kidney Champion Foundation | 01/26/2024

I fully support the initiative to better reflect the likelihood of graft failure for kidneys from African American/Black and HCV positive deceased donors.

However, I would like to emphasize that race is a social construct and should not be a factor in determining the suitability of deceased donor kidneys. The decision to include or exclude a kidney for transplantation should be based solely on medical and scientific considerations. The proposed change to remove race and HCV positive variables aligns with the principles of equity and transparency, but it is crucial to underline that racial categories should never be a part of the evaluation process.

In medical contexts, it is essential to focus on individual health factors and medical history rather than relying on race as a determinant. By eliminating race from the KDPI calculation, the organ allocation process becomes fairer and avoids perpetuating inequities associated with a social construct.

I applaud the committee's effort to enhance the KDPI for increased transparency and equity. This change not only aligns with the values of a just healthcare system but also contributes to a more inclusive and unbiased organ transplantation process.

Thank you for considering this perspective as you continue to refine and improve organ allocation policies.

Sincerely,
Crystal King

Jonathan Armenti | 01/26/2024

On behalf of the more than 90,000 individuals on the waitlist awaiting a life-saving kidney donation, I write in strong support of OPTN’s proposal to remove race and hepatitis C status as variables when calculating the Kidney Donor Profile Index.The previous policy’s inclusion of Black race as a coefficient inaccurately scored the quality and predicted function of a kidney from a deceased organ donor to be worse than that of a non-Black organ donor. This calculation was not based in science or evidence and had the unintended effect of increasing discards of otherwise viable kidneys. Race has no place in clinical calculations, and I strongly support OPTN’s proposal to correct this injustice. I encourage OPTN to adopt this proposal and move forward with its prompt implementation.

Lisa Burgess | 01/25/2024

Science and evidence should be the basis of any information gathered and/or used to on the Kidney Donor Profile Form. I strongly support removing race and hepatitis C as variable when calculating a patient's Kidney Donor Profile Index. Over 90,000 individuals need a life-saving kidney donation. No family should ever have to face losing a loved one waiting on the list.

Anonymous | 01/25/2024

On behalf of the more than 90,000 individuals on the waitlist awaiting a life-saving kidney donation, I write in strong support of OPTN’s proposal to remove race and hepatitis C status as variables when calculating the Kidney Donor Profile Index.The previous policy’s inclusion of Black race as a coefficient inaccurately scored the quality and predicted function of a kidney from a deceased organ donor to be worse than that of a non-Black organ donor. This calculation was not based in science or evidence and had the unintended effect of increasing discards of otherwise viable kidneys. Race has no place in clinical calculations, and I strongly support OPTN’s proposal to correct this injustice. I encourage OPTN to adopt this proposal and move forward with its prompt implementation.

Oliver Baer | 01/25/2024

On behalf of the more than 90,000 individuals on the waitlist awaiting a life-saving kidney donation, I write in strong support of OPTN’s proposal to remove race as a variable when calculating the Kidney Donor Profile Index. The previous policy’s inclusion of Black race as a coefficient inaccurately scored the quality and predicted function of a kidney from a deceased organ donor to be worse than that of a non-Black organ donor. This calculation was not based in science or evidence and had the unintended effect of increasing discards of otherwise viable kidneys. Race has no place in clinical calculations, and I strongly support OPTN’s proposal to correct this injustice. I encourage OPTN to adopt this proposal and move forward with its prompt implementation.

Anonymous | 01/25/2024

By maintaining race as a consideration for a life saving procedure only acts to perpetuate long standing hate and harm to people of color. Race is not a chosen attribute and BIPOC folks shouldn’t have to fight systemic racism while also fighting for their lives.

Anonymous | 01/24/2024

I have CKD and my kidney knows no race and neither do I. I just want a chance to live life to the fullest as a child of God's and humanity.

Quiana Bishop | 01/24/2024

There are many people needing kidney transplants and not being chosen as a candidate because of your race is unacceptable. Everyone is deserving of the opportunity to have a healthy life. Please change this old outdated rule.

Anonymous | 01/24/2024

On behalf of the more than 90,000 individuals on the waitlist awaiting a life-saving kidney donation, I write in strong support of OPTN’s proposal to remove race and hepatitis C status as variables when calculating the Kidney Donor Profile Index. The previous policy’s inclusion of Black race as a coefficient inaccurately scored the quality and predicted function of a kidney from a deceased organ donor to be worse than that of a non-Black organ donor. This calculation was not based in science or evidence and had the unintended effect of increasing discards of otherwise viable kidneys. Race has no place in clinical calculations, and I strongly support OPTN’s proposal to correct this injustice. I encourage OPTN to adopt this proposal and move forward with its prompt implementation.

Anonymous | 01/24/2024

There are so many people waiting & the younger a person receives a transplant the better. I received one at age 63 after being on dialysis for 3 years. If I had refused a viable kidney from a non Caucasian person, if one was available, I would have been older & maybe had other health issues! We need to erase all areas of racial bias, including transplants. My own daughter just received both a liver & a kidney which had to be from a same matching cadaver. She & I are both eternally grateful just to have a 2nd chance at life!!

Nancy Marlin | 01/24/2024

My understanding that the inclusion of race was not based on data. If so, race should clearly be removed.

Anonymous | 01/24/2024

It's about time restrictions have been lifted.

Michael Kurtz | 01/24/2024

On behalf of the more than 90,000 individuals on the waitlist awaiting a life-saving kidney donation, I write in strong support of OPTN’s proposal to remove race and hepatitis C status as variables when calculating the Kidney Donor Profile Index. The previous policy’s inclusion of Black race as a coefficient inaccurately scored the quality and predicted function of a kidney from a deceased organ donor to be worse than that of a non-Black organ donor. This calculation was not based in science or evidence and had the unintended effect of increasing discards of otherwise viable kidneys. Race has no place in clinical calculations, and I strongly support OPTN’s proposal to correct this injustice. I encourage OPTN to adopt this proposal and move forward with its prompt implementation.

Karin Ogren | 01/24/2024

On behalf of the more than 90,000 individuals on the waitlist awaiting a life-saving kidney donation and as a dialysis social worker, I write in strong support of OPTN’s proposal to remove race and hepatitis C status as variables when calculating the Kidney Donor Profile Index. The previous policy’s inclusion of Black race as a coefficient inaccurately scored the quality and predicted function of a kidney from a deceased organ donor to be worse than that of a non-Black organ donor. This calculation was not based in science or evidence and had the unintended effect of increasing discards of otherwise viable kidneys. Race has no place in clinical calculations, and I strongly support OPTN’s proposal to correct this injustice. I encourage OPTN to adopt this proposal and move forward with its prompt implementation.

Anonymous | 01/24/2024

On behalf of the more than 90,000 individuals on the waitlist awaiting a life-saving kidney donation, I write in strong support of OPTN’s proposal to remove race and hepatitis C status as variables when calculating the Kidney Donor Profile Index. The previous policy’s inclusion of Black race as a coefficient inaccurately scored the quality and predicted function of a kidney from a deceased organ donor to be worse than that of a non-Black organ donor. This calculation was not based in science or evidence and had the unintended effect of increasing discards of otherwise viable kidneys. Race has no place in clinical calculations, and I strongly support OPTN’s proposal to correct this injustice. I encourage OPTN to adopt this proposal and move forward with its prompt implementation.

Sarthak Virmani | 01/24/2024

Given the sound rationale shared by the OPTN Minority Affairs Committee members, I strongly support removing the Race and Hep C variables in calculating the KDPI score.