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Two-year monitoring report continues to show improvements in equity in access to kidney transplants for several key populations

Two-year monitoring report continues to show improvements in equity in access to kidney transplants for several key populations

A new data monitoring report contains key measures of the current kidney allocation system, which was implemented March 15, 2021 by the Organ Procurement and Transplantation Network (OPTN). The new system removed donation service area (DSA) and OPTN region from kidney allocation and replaced them with a 250 nautical mile circle around the donor hospital. These changes were projected to increase equity, and earlier monitoring reports at three monthssix months and one-year post-implementation showed increases in transplants among a number of key populations.

This most recent monitoring report presents two full years of post-implementation data. The post-policy era captured in the report experienced a 29 percent increase in overall transplant rates after the removal of DSA and region. Equity in access to transplants increased for several key populations who continue to benefit the most from the increase:

  • 38 percent for Black candidates
  • 35 percent for Hispanic candidates
  • 35 percent for Asian candidates
  • 46 percent for candidates with more than three years of dialysis time at listing
  • 40 percent for pediatric candidates aged 0—5
  • 62 percent for pediatric candidates aged 6-11
  • 49 percent for pediatric candidates aged 12-17
  • 81 percent for highly-sensitized candidates with 80-97% CPRA

Other key points to note:

  • Deceased donor kidneys are traveling further distances to be transplanted compared to the pre-policy era, although a majority are staying within the 250 nautical miles
  • The overall non-use rate for deceased donor kidneys increased from 21 percent pre-policy to 26 percent post-policy era

The report was presented to the OPTN Kidney Transplantation Committee on June 22, 2023. The OPTN monitors policies to understand whether the changes are meeting the intended goals, and to determine if they are resulting in unintended consequences. While this is the final planned monitoring report as outlined in the policy’s briefing paper, the committee will continue to monitor these policies and will request additional data monitoring as needed. Previous monitoring reports for these policy changes are available on the OPTN website.


The changes to kidney allocation resulted from the Health Resources and Services Administration (HRSA) 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.

Read the 2019 public comment on the proposal to eliminate the use of DSA and region in kidney allocation, then learn more about the OPTN policy development process.

The future state of kidney allocation

In 2019, the OPTN began work to adopt a single distribution framework that could be adapted to all organ types. This approach, continuous distribution, is a points-based system predicted to increase equity among potential recipients. Lung was the first organ type to adopt continuous distribution, and kidney and pancreas are currently moving through a series of steps as the framework is developed for their organ types.

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