A data monitoring report now available on the Organ Procurement and Transplantation Network website shows a continuation of promising trends in kidney transplantation following implementation of new allocation policies earlier this year.
The Oct. 8 report contains key measures of the first three and a half months of the new kidney policies implemented March 15, when a system of 250 nautical mile (NM) circles replaced the outdated system based on donation service areas (DSAs) and OPTN regions. The changes were projected to increase equity in access to transplant for kidney and pancreas candidates across the country by distributing organs more fairly to people waiting for an organ.
Key post-implementation data takeaways from the Oct. 8 report include:
- Kidney transplant volumes were up across all ethnicities, and blood types
- The proportion of pediatric kidney transplants increased from less than 3 percent pre-policy to more than 3.5 percent of deceased donor kidney transplants in the post-policy period
- Candidates with moderate CPRA and kidney patients with longer dialysis times also saw increases in transplant volume
- The average number of transplants per week post-policy increased by 19 percent when compared to the pre-policy period
- Approximately 70 percent of transplant hospitals had the same or more kidney transplants post- vs. pre-policy
- The proportion of transplants occurring within 250 NM of the donor hospital increased, as has the number of transplants are occurring outside of the donor DSA
- The majority of OPTN regions experienced an increase in transplant volume, and the discard rates remained stable
These findings are consistent with a previous June 18 monitoring report that showed similar results for the first two months of post-implementation data.
Broader distribution gets organs to the sickest patients
The data in the most recent monitoring report point to how the new circle-based policies are an improvement over the previous system of DSAs and regions, which were never optimized for organ distribution. The changes are helping to ensure that organ allocation is based on the medical needs of patients rather than artificial boundaries related to organ recovery. For example, the Oct. 8 report reveals that median time on dialysis at time of transplant has increased from 4.1 to 4.5 years post-implementation. This increase was predicted by the simulation modeling used to inform development of the policies, and shows that sicker patients with higher dialysis times are in fact getting transplanted under the new system as kidneys are distributed more broadly. Simulation modeling also predicted that the median distance from donor hospital to transplant hospital would increase, with a greater proportion occurring within 250 NM of the donor hospital.
The Kidney Transplantation Committee will continue to monitor this policy as data are submitted, and subsequent monitoring reports will be posted on an ongoing basis.