Improving access for kidney and pancreas allocation

Making kidney and pancreas distribution more fair and equitable

About policy development

In its role as the Organ Procurement and Transplantation Network (OPTN), UNOS convenes the donation and transplant community to develop policies that provide fair and equitable access for patients to transplant. Many times during the past 30 years, these policies have been updated by the OPTN Board of Directors to balance the needs of patients nationwide and keep pace with the emerging science of transplantation.

Reducing disparities

OPTN organ allocation policies, developed by clinical experts from across the country, have greatly reduced differences in patient access to kidney and pancreas transplants based on factors such as their ethnicity and age. At this time, the factor most strongly associated with disparities in timely access to deceased donor kidney transplants is the geographic location of the patient’s transplant hospital. This is largely the result of inconsistently drawn local and regional boundaries known as donation service areas (DSAs) historically used in organ allocation.

For example, under the previous DSA-based system, a patient who was at a hospital 15 miles west of a donor hospital may have been in a completely different local or regional area than another patient 15 miles east of the same donor. The patient who was not in the same local or regional area as the donor would not appear on a list of potential matches until many other candidates were offered that organ—some of whom may have been hundreds of miles away.

New policy improves distribution

Using statistical simulation modeling and input from transplant clinicians and the public, the OPTN has replaced decades-old, inconsistent geographic boundaries used in organ allocation. The new, consistent distribution units are based on the relative distance from donor hospital to transplant hospital.

In December 2019, the OPTN board approved a proposal that, for most allocations, prioritizes kidney and pancreas offers for candidates listed at transplant hospitals within a 250 nautical-mile radius of the donor hospital, then to candidates at transplant hospitals beyond 250 nautical miles.

How does it work?

While logistical considerations differ in some parts of the country, 250 nautical miles is often considered a dividing point between modes of organ transportation. Kidneys and pancreata used within that radius often travel by ground to the transplant hospital; organs that travel farther are often transported by air.

The system awards additional priority to patients at each of the two levels of distribution—first within the 250 nautical-mile radius, then beyond 250 nautical miles.

Candidates receive proximity points. The maximum value is awarded for those at transplant hospitals closest to the donor hospital with proportionally fewer awarded for those farther from the donor location. This reduces the likelihood of organ offers “crisscrossing” within the distribution area for patients who have the same need for a transplant but are just slightly closer to or farther away from the donor.

Who will benefit?

Statistical simulation modeling projects that the new policy will improve transplant access for key groups of transplant candidates, including:

• Children
• Ethnic minorities
• Candidates who are very hard to match for biological reasons

As with all allocation policies, it will be closely monitored and any needed changes will be made to address unexpected outcomes.