In late 2020, the Organ Procurement and Transplantation Network will implement policies to remove donation service area (DSA) and OPTN region from kidney and pancreas allocation.
At implementation, DSA and region will be replaced with a 250 nautical mile (NM) fixed circle and there will be substantive changes to the policy and process for “local backup” of these organs if the original intended recipient is unable to be transplanted. The exact date of implementation is not yet finalized but is planned for mid-December of this year.
Statistical modeling indicates that removing DSA and region from allocation will increase transplant access for key groups of transplant candidates, including children, women, ethnic minorities and those who are hard to match due to high immune sensitivity.
In addition to the policies to remove DSA and region from kidney and pancreas allocation, three other policies will be implemented simultaneously to address:
- How deceased donor kidneys and pancreata from Alaska are distributed in the new system
- How organ procurement organizations (OPOs) will reallocate released kidneys and pancreata in the new system
- How medically urgent kidney candidates are prioritized in the new system
Policy toolkits now available
More information about the changes involved with these policies can be found in the Professional Education section of the OPTN website. The following toolkits are now available:
- Removal of DSA and Region from Kidney Allocation Toolkit
- Removal of DSA and Region from Pancreas Allocation Toolkit
- Modifications to Released Kidney and Pancreas Allocation Toolkit
- Addressing Medically Urgent Candidates in the New Kidney Allocation System Toolkit
The policy toolkits pages in the Professional Education section of the OPTN website will be regularly updated with resources as they are developed. Transplant, OPO and histocompatibility lab professionals will receive regular communications about information related to implementation in the coming months.
Frequently asked questions
What impact do these changes have on the existing Kidney Allocation System (KAS)?
KAS was implemented in 2014 and is still in effect. The aspects of KAS addressing prioritization of transplant candidates, including estimated post-transplant survival (EPTS), and of assessing donor longevity potential, including kidney donor profile index (KDPI), will not change as a result of policies affecting kidney distribution. The upcoming changes will impact match sequencing in KAS. Instead of relying on DSA and region, kidney allocation will be based on geographical distance between donor and recipient. Find more information about KAS here.
What impact do these changes have on the existing Pancreas Allocation System (PAS)?
PAS was implemented in 2014 and is still in effect. The upcoming changes will impact match sequencing in PAS. Instead of relying on DSA and region, pancreas and kidney-pancreas allocation will be based on geographical distance between donor and recipient. Find more information about PAS here.
I’m an OPO professional—how can I learn about the modifications to released kidney and pancreas allocation?
There will be significant changes to the policies that determine the “backup” priority for these organs. The new released organ allocation policies address the reallocation of kidney, kidney-pancreas, pancreas, and islets in situations in which an organ allocated to an original intended recipient is unable to be transplanted in that recipient.
For released kidneys, the major change will be that the host OPO will maintain responsibility for any necessary continued allocation either using the original match run or a new match run with a 250NM circle around the intended recipient hospital. The allocation of released kidneys will no longer be done at the importing OPO or DSA level.
There are also changes to released kidney-pancreas, pancreas, and islets. Professional education resources are in development for OPO staff. Find a summary of the policy changes and a visual aid to the reallocation processes in the new system on the policy’s toolkit page.
Why are DSA and region being removed from kidney and pancreas allocation?
These improvements to kidney and pancreas allocation developed as a result of the OPTN Board of Directors’ 2018 directive that organ-specific committees remove DSA and region from allocation policies to align with the OPTN Final Rule. The Final Rule requires that policies “shall not be based on the candidate’s place of residence or place of listing, except to the extent required” by the other requirements of the Rule. The changes mean that match sequencing will be based on geographical distance between donor and recipient instead of fixed DSA and regional boundaries.
When were these policies approved?
After taking into consideration the feedback generated through two cycles of public comment, the OPTN Board of Directors approved removing DSA and region from kidney and pancreas at its December 2019 meeting. The additional policies addressing Alaska allocation, prioritization of medically urgent kidney candidates, and OPO processes related to reallocating released organs were approved at the Board’s June 2020 meeting. Find all updates on the kidney and pancreas policy page.
How will offers be made in the new system?
In the new system, kidney and pancreas offers (except for rare, very well-matched donor and recipient combinations nationwide) will be offered first to candidates listed at transplant hospitals within 250 NM of the donor hospital. Offers not accepted for any of these candidates will then be made for candidates beyond the 250 NM distance. Kidney and pancreas candidates will receive proximity points in the new system that prioritize them within their classification. Find detailed information in the policy notices on the kidney policy toolkit page and the pancreas policy toolkit page.
When will these policies be implemented?
The exact implementation date is still being finalized and is scheduled for mid-December of this year.
How do proximity points work in the new system?
A candidate’s proximity points will be based on the distance between their transplant program and the donor hospital. Proximity points are intended to improve the efficiency of organ placement by adding priority for candidates closer to the donor hospital. Mandatory national shares still apply. Learn more about proximity points and find a visual aid on the policy’s toolkit page.
I am a transplant professional and have medically urgent candidates in my care. How will the new policy impact their prioritization?
It will be necessary to train staff on new processes for obtaining priority for medical urgency in Waitlist℠. There will be a two-week transition period for medical urgency status ahead of implementation, and staff will need to enter data for any existing medically urgent candidates into the Waitlist data collection tool ahead of implementation in order to ensure that current medically urgent candidates receive priority immediately under the new policy, assuming they meet the criteria of the policy definition. Information regarding the new Medical Urgency section, including examples as well as details around entering and editing the data, will be available in the online help documentation within Waitlist during the transition period. Professional education resources are in development and will be shared ahead of implementation, along with more details about the transition period. Find more information about prioritization of medically urgent kidney candidates in the new system on the policy’s toolkit page.
When will professional education materials be available on UNOS Connect?
Several professional education trainings are in development and will be released to the community ahead of implementation. These trainings will educate members on:
- The removal of DSA and region from kidney and pancreas
- Distribution of deceased donor kidneys and pancreata recovered in Alaska
- How OPOs will allocated released kidney and pancreata in the new allocation system
- How medically urgent kidney candidates are prioritized in the new allocation system
Members will receive regular communications about the launch of professional education resources and online trainings, and they will be published on the toolkit pages on the Professional Education section of the OPTN website.
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