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Improving Dual Kidney Allocation

Improving Dual Kidney Allocation. Kidney Transplantation Committee. What problem will the proposal solve?. D iscard rates for high KDPI kidneys is at or above 50% Policy 8.6: Dual Kidney Allocation needs to be updated to promote efficient placement. What are the proposed solutions?.

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Improving Dual Kidney Allocation

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  1. Improving Dual Kidney Allocation Kidney Transplantation Committee

  2. What problem will the proposal solve? • Discard rates for high KDPI kidneys is at or above 50% • Policy 8.6: Dual Kidney Allocation needs to be updated to promote efficient placement

  3. What are the proposed solutions? • Sequences C & D include single and dual opt-in allocation • Combined Local + Regional classification removed

  4. Supporting Evidence: Donors KDPI >85% with at least One Match Acceptance of En Bloc or Dual Kidneys, 2010-2015 • 98.6% transplanted at accepting center • 4.8% (31) pairs were split, and 5 of 31 left the accepting center • 1.4% (9 of 645) at least one kidney transplanted at different center (N=645)

  5. How will members implement this proposal?

  6. How will the OPTN implement this proposal?

  7. Questions? Nicole Turgeon, MD Kidney Committee Chair nturgeo@emory.edu Chelsea Rock Haynes, MPA Kidney Committee Liaison chelsea.haynes@unos.org

  8. Extra Dual/En Bloc Slides

  9. What does it mean to “release” per 5.9? • Releasing organs is current practice. The risk of accepting an organ that can’t be transplanted into the originally intended recipient is always present. • In these scenarios, the organ is “released” to the OPO to determine whether and how the organ can be reallocated. It rarely means physically shipping it back to the host OPO. • If implemented, new functionality in DonorNet will streamline this process for en bloc kidneys. OPTN Policy 5.9 states programs must: “…Release the…organs back to and notify the host OPO…for further distribution. The host OPO must then allocate the organ to other candidates...”

  10. Policy 5.9 Released Organs The transplant surgeon or physician responsible for the care of a candidate will make the final decision whether to transplant the organ. The transplant program must transplant all accepted, deceased donor organs into the originally designated recipient or release the deceased donor organs back to and notify the host OPO or the OPTN Contractor for further distribution. If a transplant program released an organ, it must explain to the OPTN Contractor the reason for refusing the organ for that candidate. The host OPO must then allocate the organ to other candidates according to the organ-specific policies. The host OPO may delegate this responsibility to the OPTN Contractor or to the OPO serving the candidate transplant program’s DSA.

  11. Deceased Donor Kidney Transplants 12/4/2014-11/30/2016 by OPTN Region and Kidney Transplant Type

  12. KDPI and risk adjustment • The PSRs currently include “procedure type” as a factor: • Left kidney • Right kidney • Double kidney • En bloc kidney • There is no extra risk (or reduction of risk) associated with procedure type • The risk-adjustment model will not harm or reward programs for completing en bloc transplants

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