UNOS is aware of questions regarding the prioritization of living organ donors under the new continuous distribution framework, specifically as it relates to kidney allocation.
We wish to assure the community that the OPTN Kidney Transplantation Committee intends for both prior and future living donors to receive the same level of priority for a deceased donor organ in the new framework as they receive in the current allocation system.
The final policy proposal for continuous distribution of kidneys is still being developed and we appreciate every public comment that we have received to aid in its creation. All feedback shared in public comment is considered in the overall policy development process. We are especially grateful for the patients, families, and living donors who take the time to share their perspectives
The continuous distribution framework
The continuous distribution framework is a new way to manage organ allocation that will enable the Organ Procurement and Transplantation Network (OPTN) to match donated organs to patients with greater efficiency, equity, and transparency.
Under continuous distribution, each patient receives a composite allocation score based on a holistic review of their unique characteristics, as well as the donor’s characteristics, each time an organ becomes available. The new framework is sensitive to each patient’s individual medical history, including their status as a prior living donor.
Being a prior living donor is a significant aspect of a person’s medical history, like being biologically harder to match. That’s why these characteristics are intended to be prioritized under continuous distribution of kidneys.
Continuous distribution goals include
- Prioritize sickest candidates first to reduce waitlist deaths
- Increase transplant opportunities for candidates with distinct characteristics like candidates under the age of 18 or prior living donors
- Increase transplant opportunities for patients who are medically harder to match
Continuous distribution was approved by the OPTN board of directors in 2018 and implemented for lung allocation on March 9thof this year. Over the coming years, the OPTN intends to transition all other solid organs to this framework.
Previously, only patients in need of a kidney transplant would receive priority for being a prior living donor. This has changed under the continuous distribution launch for lung: Now, all prior living donors will also receive greater priority for lung transplants. Prior living donor priority status will also be considered as an attribute for increased transplant opportunities in developing policy proposals for other organ types.
Living organ donors make thousands of additional transplants possible each year. We are eternally grateful to each of them for their roles in helping save as many lives as possible.
More information on continuous distribution
Work to transition all organ types to the continuous distribution framework is proceeding. Each organ type will go through special exercises known as “values prioritization exercise,” to gather feedback from stakeholders, patients, and the public on how various allocation factors should be weighted relative to one another.
Kidney, pancreas and liver organs have already been through the values prioritization exercise. Heart is anticipated to go through the values exercise next.
