On July 18, as part of the response to the Executive Order on Advancing American Kidney Health, the OPTN will launch the Kidney Accelerated Placement Project (KAPP) to assess whether accelerating the placement of extremely hard-to-place kidneys via the Organ Center can increase their utilization. The KAPP was developed to improve placement of national kidney offers and was based on feedback from the community.
The project’s accelerated placement of hard-to-place kidneys will be tested on national kidney allocations coordinated by the Organ Center. OPTN policy requires all OPOs to transfer kidney matches that reach national allocation to the UNOS Organ Center. The KAPP is an organ placement innovation that does not require a change in OPTN policy. The KAPP affects only those hard-to-place kidneys that the Organ Center already offers as part of the national allocation process.
The project’s goal is to transplant more hard-to-place kidneys during the national allocation phase by having the Organ Center offer them to centers with an established history of transplanting them.
A safety and monitoring council will be monitoring data regularly to determine if this project results in more effective placement of these organs.
Q: What is the Kidney Accelerated Placement Project (KAPP)?
A: A pilot project testing a process for increasing utilization of a sub-set of hard-to-place kidneys. This project will allow difficult-to-place kidneys to reach patients at centers that have previously accepted and transplanted medically similar kidneys earlier, potentially minimizing the accumulation of cold ischemic time. The offer can then be extended to other centers on the match if not accepted. Qualifying acceptance patterns will be updated monthly.
Q: When does the KAPP begin?
A: The KAPP launches July 18, 2019 and will last for one year. The safety and monitoring council will develop stopping criteria that will trigger an early end to the project if expected outcomes on national kidney offer acceptance are unmet.
Q: I am at a transplant center. What will Kidney Accelerated Placement mean for my center?
A: You do not need to change any practices. Your center will continue to get national kidney offers, and you will continue to accept or decline them.
Q: I am at an OPO. What will Kidney Accelerated Placement mean for my organization?
A: You do not need to change any practices. OPTN policy already requires OPOs to turn over organ allocation to the Organ Center when a kidney gets to the national level for placement.
Q: What kind of oversight will this pilot have?
A: This time-limited project will have oversight by a Safety and Monitoring Council made up of physicians and OPO executives. They will monitor outcomes and discards in real-time, evaluate the pilot structure, meet quarterly to discuss progress, and identify stopping criteria for the pilot. The Council will also be tasked with creating recommendations at the end of the pilot for the OPTN Board to consider.
*Q: What are “hard-to-place” kidneys?
“Hard-to-place” kidneys that will qualify for accelerated placement will be national kidney offers made by the Organ Center on kidney matches for adult donors with a KDPI of 80 or higher. Kidneys from these donors will have been previously offered for any “mandatory” shares (0-ABDR mismatches and highly sensitized candidates at the top of the match run) and offered to all transplant programs at both the local and regional levelbefore being accelerated.
*Q: How does my program qualify for accelerated placement offers?
All national kidney transplant programs will still be eligible to receive all national offers, but the goal of the project is to accelerate the offers of hard-to-place kidneys first to the programs with an established history of transplanting them. There is not a static “accelerated placement” transplant program designation. Accelerated placement transplant programs are determined independently for each donor at the time of allocation. If a transplant program has transplanted a kidney with similar or more marginal donor characteristics in the past, the program will receive accelerated placement offers for that particular match if the kidney reaches the national level and qualifies as hard-to-place.
*Q: What criteria will be used to determine if a program accepts hard-to-place kidneys?
For determining a transplant program’s history of transplanting a kidney with similar or riskier donor characteristics, all deceased donor transplants (including local transplants) from the prior two years are included. The two-year history will be refreshed monthly to account for any changes in kidney transplant characteristics over time. The donor characteristics that are used to determine accelerated placement transplant programs are transplants from donors with similar or riskier donor KDPI, age, peak serum creatinine, history of diabetes, history of IV drug use, and donation after circulatory death status.
Donation and transplant professionals who have questions about the Kidney Accelerated Placement Project, please contact the OPTN at firstname.lastname@example.org.
For other questions, please refer to the UNOS contact page.
*added July 25, 2019