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Kidney and pancreas policy

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pancreas icon

Making kidney and pancreas distribution more equitable

With more than 90,000 people waiting for a lifesaving kidney transplant, ensuring equitable allocation of kidneys is a priority for the entire donation and transplant community.

New kidney and pancreas policies were implemented on March 15, 2021, and are improving access for key groups of candidates, including children, women, ethnic minorities and candidates who are particularly hard to match for biological reasons. Working together to continuously improve the system, UNOS and the donation and transplant community, including patients and families, developed these policies to increase equity in transplant access across the U.S.

But kidney and pancreas policy is still undergoing transformation – learn about continuous distribution, the future state of kidney and pancreas allocation.

Frequently asked questions

Essential reading

Policy development, community discussion and tools helping to ensure equitable distribution of donated organs.

In focus

16% increase in kidney transplants

Kidney transplants increase

July 1, 2022: One-year monitoring report shows increases in kidney transplants for Black, Hispanic, Asian and pediatric patients following policy changes.

in focus

Analysis: equity in the COVID-19 era with icon of balanced scale and kidneys


Sept. 8, 2021: UNOS researchers present pre-COVID and COVID-era kidney transplant equity data at the 2021 American Transplant Congress.


UNOS researchers Darren Stewart and Alesha Henderson

Equity in access to transplant

June 10, 2021: UNOS researchers discuss how the OPTN data dashboard tracks equity through Access to Transplant Score.

Building a new, more flexible system for organ allocation


New kidney and pancreas allocation system will increase equity

New kidney and pancreas allocation system will increase equity

Mar. 17, 2021: One example of how data-driven policy development helps patients

A step on the path toward continuous distribution of organs

The new policies removed donation service area (DSA) and OPTN region from kidney and pancreas allocation. While this is an important step toward more equitable allocation of organs, it’s not the end of the work to improve the system for patients.

The organ donation and transplant community is working together to introduce a new framework called continuous distribution. This new system is more fair and flexible because it will move organ allocation away from placing and considering patients by classifications and allow it to consider multiple factors all at once using an overall score. Doing so will dissolve hard boundaries that exist in the current category-based system. A continuous distribution framework will ensure that no single factor determines a patient’s priority on the waiting list.

Read more about continuous distribution and learn how patients will benefit.

Frequently asked questions

New FAQ for patients: CPRA calculation change
Why were DSA and region removed from kidney and pancreas allocation?

The new kidney and pancreas allocation systems replaced a highly inconsistent set of local and regional boundaries historically used to allocate these organs. The new systems provide a consistent mechanism that treats transplant recipients equitably based on the distance between their transplant hospital and that of the organ donor.

These improvements 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 is now based on geographical distance between donor and recipient instead of fixed DSA and regional boundaries. This ensures that the system is based appropriately on the medical needs of patients rather than artificial dictates of geography.

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 EPTS, and of assessing donor longevity potential, including KDPI, have not changed as a result of policies affecting kidney distribution. The changes impact match sequencing in KAS. Instead of relying on DSA and region, kidney allocation is 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 changes impact match sequencing in PAS. Instead of relying on DSA and region, pancreas and kidney-pancreas allocation are based on geographical distance between donor and recipient.

Find more information about PAS here.

When were these policies approved?

After taking into consideration the feedback generated through two cycles of public comment, the Board 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.

How are offers being made in the new system?

In the new system, kidney and pancreas offers (except for rare, very well-matched donor and recipient combinations nationwide) are offered first to candidates listed at transplant hospitals within 250 NM of the donor hospital. Offers not accepted for any of these candidates are then made for candidates beyond the 250 NM distance. Kidney and pancreas candidates receive proximity points in the new system that prioritize them within their classification.

Find detailed information in the policy notices on the policy toolkit pages.

How do proximity points work in the new system?

A candidate’s proximity points are 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 on the policy’s toolkit page.

What is the future state for kidney-pancreas allocation policy?

During summer 2020, the Kidney Transplantation and Pancreas Transplantation committees began work to transition kidney and pancreas policy to the continuous distribution framework. The community was asked to provide feedback through an online survey and a request for feedback paper during winter 2022 public comment.

Magnifying glass inspecting data charts

How do we track policy success?

We look at the data.

Kidney transplant volumes up 31% for patients on dialysis*

Policy monitoring reports

*One-year report of kidney data

Kidney-pancreas quick links

What happened in public comment?

See what the community had to say.

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