Revised national kidney transplant allocation system to match kidneys more effec

[Clark]

http://transplantpro.org/revised-national-kidney-transplant-allocation-system-match-kidneys-effectively-improve-access-hard-match-patients/

Revised national kidney transplant allocation system to match kidneys more effectively and improve access for hard-to-match patients

Effective December 4, 2014, the national computerized system that matches kidneys from deceased donors with patients needing transplantation has been revised significantly.
Candidates who were listed for a kidney transplant prior to the implementation of the new system will not lose any priority on the waiting list.  The great majority of kidney matches will continue to take place under policies that have been in place for a number of years.  The revised policies are meant to provide additional transplant opportunities for all candidates, and to improve access for specific groups of patients who have traditionally waited longer than average for a transplant.
“The revised system reflects years of study and discussion involving transplant professionals, people personally affected by transplantation, and the general public,” said Carl Berg, M.D., OPTN/UNOS president.  “There is broad consensus that this system preserves the strengths of existing kidney policy while improving it in ways that will help many more people.”
Key goals of the new system include:
Extending the length of time kidney recipients may have a functioning transplant
Making better use of available kidneys through increasing organ usage and reducing the need for repeat transplants
Improving the likelihood of receiving a transplant for candidates who are difficult to match with most donors
To achieve these goals, a number of new and revised policies will be implemented.  Key features of the new system include:
Individual calculations of the likely length of function of a donor kidney and of the expected length of time an adult candidate may need a kidney transplant
Priority matching of kidneys likely to function the longest with candidates likely to need a kidney for the longest amount of time
Revisions to blood type matching to provide more opportunities to candidates with more rare types
Increased priority for candidates whose immune system is not compatible with most donor kidneys
Calculation of transplant waiting time (a key factor in allocation priority) from the date a patient begins dialysis, even if he or she started dialysis before being accepted for listing at a transplant center
Elimination of kidney payback offers and local logistical exceptions to the national system
The OPTN/UNOS Kidney Transplantation Committee will actively study the effects of the newly implemented system and will consider any future revisions or additions to ensure it meets the needs of candidates in the fairest manner possible.
A number of resources are available to help transplant professionals with policy implementation and to help transplant candidates understand the new system.
United Network for Organ Sharing (UNOS) serves as the Organ Procurement and Transplantation Network (OPTN) by contract with the U.S. Department of Health and Human Services, Health Resources and Services Administration, Division of Transplantation. The OPTN brings together medical professionals, transplant recipients and donor families to develop national organ transplantation policy.

http://optn.transplant.hrsa.gov/learn/professional-education/kidney-allocation-system/

[Fr Pat]

     Does anyone know about the new situation of living kidney donors who later need a kidney transplant? Are any sort of advantages or preferences included in the new system?
     Fr. Pat

[Clark]

The simple answer is, no change, still 4 points. The system is different, so there's more of a range of what this implies individually, and geographic disparity is not yet addressed, so this varies by DSA, but regardless of which range(s) of KDPI we and our nephrologists are willing to consider, we are still able to ask for a 4 point boost.

http://optn.transplant.hrsa.gov/ContentDocuments/OPTN_Policies.pdf#nameddest=Policy_08

Policy 8: Allocation of Kidneys (As of 12/4/14)
(Section) 8.3 Points
Table 8-1: Kidney Points
If the candidate is:
And the following allocation sequence is used:
Then the candidate receives this many points:

A prior living donor
8.5.H, 8.5.I, or 8.5.J
4 points

(Section) 8.5 Kidney Allocation Classifications and Rankings

8.5.H Allocation of Kidneys from Deceased Donors with KDPI Scores less than or equal to 20%
Kidneys from deceased donors with a kidney donor profile index (KDPI) score of less than or equal to 20% are allocated to candidates according to Table 8-5 below.

Table 8-5: Allocation of Kidneys from Deceased Donors with KDPI Less Than or Equal To 20%

Classification
Candidates that are within the:
And are:
When the donor is this blood type:

40
OPO’s DSA
Prior living donor, blood type permissible or identical
Any

8.5.F Prior Living Organ Donors
A kidney candidate will be classified as a prior living donor if all of the following conditions are met:
5. The candidate donated for transplantation, within the United States or its territories, at least one of the following:
 Kidney
 Liver segment
 Lung segment
 Partial pancreas
 Small bowel segment.
6. The candidate’s physician reports all of the following information to the OPTN Contractor:
a. The name of the recipient or intended recipient of the donated organ or organ segment
b. The recipient’s or intended recipient’s transplant hospital
c. The date the donated organ was procured

8.5.I Allocation of Kidneys from Deceased Donors with KDPI Scores Greater Than 20% but Less Than 35%

Kidneys from deceased donors with KDPI scores greater than 20% but less than 35% are allocated to candidates according to Table 8-6 below.

Table 8-6: Allocation of Kidneys from Deceased Donors with KDPI Scores Greater Than 20% but Less Than
35%

Classification
Candidates that are within the:
And are:
When the donor is this blood type:

40
OPO’s DSA
Prior living donor, blood type permissible or identical
Any

8.5.J Allocation of Kidneys from Deceased Donors with KDPI Scores Greater than or Equal to 35% but Less than or Equal to 85%

Kidneys from donors with KDPI scores greater than or equal to 35% but less than or equal to 85% are allocated to candidates according to Table 8-7 below.

Table 8-7: Allocation of Kidneys from Deceased Donors with KDPI Greater Than or Equal To 35% and Less
Than or Equal To 85%

Classification
Candidates that are within the:
And are:
When the donor is this blood type:

40
OPO’s DSA
Prior living donor, blood type permissible or identical
Any