Improving access for kidney and pancreas allocation

Making kidney and pancreas distribution more fair and equitable

About policy development

In its role as the Organ Procurement and Transplantation Network (OPTN), UNOS convenes the donation and transplant community to develop policies that provide fair and equitable access for patients to transplant. Many times during the past 30 years, these policies have been updated by the OPTN Board of Directors to balance the needs of patients nationwide and keep pace with the emerging science of transplantation.

Reducing disparities

OPTN organ allocation policies, developed by clinical experts from across the country, have greatly reduced differences in patient access to kidney and pancreas transplants based on factors such as their ethnicity and age. At this time, the factor most strongly associated with disparities in timely access to deceased donor kidney transplants is the geographic location of the patient’s transplant center. This is largely the result of inconsistently drawn local and regional boundaries known as donation service areas (DSAs) historically used in organ allocation.

For example, under the current distribution system, a patient who is at a hospital 15 miles west of a donor hospital may be in a completely different local or regional area than another patient 15 miles east of the same donor. The patient who is not in the same local or regional area as the donor will not appear on a list of potential matches until many other candidates are offered that organ—some of whom may be hundreds of miles away.

New policy improves distribution

Using statistical simulation modeling and input from transplant clinicians and the public, the OPTN is replacing decades-old, inconsistent geographic boundaries used in organ allocation. The new, consistent distribution units are based on the relative distance from donor hospital to transplant hospital.

In December 2019, the OPTN board approved a proposal that, for most allocations, prioritizes kidney and pancreas offers for candidates listed at transplant hospitals within a 250 nautical-mile radius of the donor hospital, then to candidates at transplant hospitals beyond 250 nautical miles.

How does it work?

While logistical considerations differ in some parts of the country, 250 nautical miles is often considered a dividing point between modes of organ transportation. Kidneys and pancreata used within that radius often travel by ground to the transplant hospital; organs that travel farther are often transported by air.

The system awards additional priority to patients at each of the two levels of distribution—first within the 250 nautical-mile radius, then beyond 250 nautical miles.

Candidates will receive proximity points. The maximum value will be awarded for those at transplant hospitals closest to the donor hospital with proportionally fewer awarded for those farther from the donor location. This will reduce the likelihood of organ offers “crisscrossing” within the distribution area for patients who have the same need for a transplant but are just slightly closer to or farther away from the donor.

Who will benefit?

Statistical simulation modeling projects that the new policy will improve transplant access for key groups of transplant candidates, including:

  • Children
  • Ethnic minorities
  • Candidates who are very hard to match for biological reasons

As with all allocation policies, it will be closely monitored from the date of implementation and any needed changes will be made to address unexpected outcomes.

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Our mission is to unite and strengthen the donation and transplant community to save lives.

About UNOS 

UNOS is a non-profit, charitable organization that serves as the nation’s Organ Procurement and Transplantation Network (OPTN) under contract with the federal government. The OPTN helps create and define organ allocation and distribution policies that make the best use of donated organs. This process involves continuously evaluating new advances and discoveries so policies can be adapted to best serve patients waiting for transplants. All transplant programs and organ procurement organizations throughout the country are OPTN members and are obligated to follow the policies the OPTN creates for allocating organs. 

For more information

A summary of the work and study that led to the OPTN Board of Directors’ adoption of a new system for matching kidney and pancreas transplant candidates with organs from deceased organ donors is available here

A dynamic map showing relative distances from transplant hospitals to potential donor hospitals is available here

A briefing paper that summarizes the proposal as adopted is available here

Learn more about how we develop policy here

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