Kidney Allocation Policy Development

Mission

The National Organ Transplant Act (NOTA) requires that the Organ Procurement and Transplantation Network (OPTN) develop medical criteria for equitable organ allocation. The allocation policy has always balanced considerations of justice and utility in organ allocation. Over time, the kidney allocation formula has become unbalanced because the utility component (HLA matching) has diminished in emphasis.

The OPTN/UNOS Kidney Transplantation Committee is charged with reviewing the current kidney allocation system and making recommendations for improvement of the system.

Background

The current kidney allocation system has been in place for over 20 years. During this time, some changes have been made, but the system cannot keep up with current trends in medicine. As waiting times for kidney transplant increase throughout the United States, the need for review of the current system and discussion of possible revisions is great.

Under consideration

The OPTN/UNOS Kidney Transplantation Committee considered many concepts and approaches to allocation over four years. Throughout its review, the committee has been including concepts that meet the requirements of the OPTN Final Rule and the UNOS Statement of Principles and Objectives of Equitable Organ Allocation. The committee is now considering the following three concepts which would work together to determine a candidate Kidney Allocation Score (KAS):

  • Life Years from Transplant (LYFT): Determines the estimated survival that a recipient of a specific donor kidney may expect to receive versus remaining on dialysis. LYFT is primarily a measure of utility.
  • Dialysis Time (DT): Time spent on dialysis allows candidates to gain priority over the period they receive this treatment, adding the essential element of justice into the allocation system.
  • Donor Profile Index (DPI): Provides a continuous measure of organ quality based on clinical information. DPI increases individual autonomy by providing a better metric for deciding which organs are appropriate for which candidates. LYFT, DPI, and DT are incorporated so that kidneys are matched to candidates based on the expected survival of both the kidney and the recipient.

Currently, the concepts are under review by the U.S. Department of Health and Human Services (HHS) Office of Civil Rights (OCR). The OCR is assessing whether the concepts are consistent with applicable federal laws, including the Age Discrimination Act. If OCR finds the concepts to be consistent, we will circulate a formal proposal for public comment.

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