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Continuous distribution - kidney and pancreas

The kidney and pancreas organ types began continuous distribution work in summer 2020. The Kidney and Pancreas Committees are on a parallel timeline to complete the development of the framework for each of their organ types.

The Kidney and Pancreas Committees are following a series of steps as they work to build and implement the framework. Below you will find more information about what has been involved with each step of the process as well as the status of each step and any results to date.

Specific attributes labeled in boxes in a line next to each other separated by arrow signs. Identify attributes, build framework, modeling and analysis, public comment on policy proposal, board approved, policy implemented. Mobile image. Specific attributes labeled in boxes in a line next to each other separated by arrow signs. Identify attributes, build framework, modeling and analysis, public comment on policy proposal, board approved, policy implemented. Desktop image.

1. Identify attributes — status complete

The Kidney and Pancreas Committees considered several attributes before deciding those that would contribute to the overall composite allocation score. The identified attributes align with NOTA and the OPTN Final Rule. Any attribute that is based in part on a candidate’s location or listing is only permitted to the extent required by another regulatory factor. The Committees began with the attributes that are in current policy and considered additional attributes suggested during summer 2021 public comment in the form of a concept paper. An additional concept paper was released for public comment in early 2022. The committees are regularly updating the community about their progress.

2. Build framework — in process

The step involves converting the existing allocation policies for kidney and pancreas into the new framework through the following exercises, and will involve community input.

Prioritizing attributes against each other

The specific weight of each attribute determines how much influence each attribute will have toward the overall score.

Community input was collected during the winter 2022 public comment cycle, using a method called Analytic Hierarchy Process, or AHP. An AHP exercise shows each participant a pair of attributes that will be used to prioritize candidates. The participant must decide, if all else is considered equal, which of the two attributes is more important than the other when prioritizing a candidate for an organ.

Video: Continuous distribution — Factors related to kidney allocation in the current system

Video: Continuous distribution — Factors related to pancreas allocation in the current system


Watch these recordings to learn how allocation works in the current kidney and pancreas systems. These presentations explain how attributes may be used in the new continuous distribution framework. Stakeholder input was collected during AHP exercises as the community works to bring continuous distribution to all organ types.

Converting attributes into points

For each attribute that will be factored into the overall score, the Kidney and Pancreas Committees will recommend how to assign points to candidates according to differences in the attribute itself. For example, how many points do we give to blood type A versus AB? 100 miles versus 1,000 miles?

Conducting sensitivity analysis

A sensitivity analysis is an analysis used by statisticians to change a single variable slightly to measure the impact on an outcome. For continuous distribution of kidneys and pancreata, a sensitivity tool is used to evaluate these variables. For example, if a change is made to the weight of any attribute, the new match run will be shown as the outcome.

Explore the dashboards to better understand a potential composite allocation score. The sample candidate data in these interactive workbooks are not meant to represent specific candidates, but are intended to reflect how a possible match run might be scored and ranked.

Developing the composite score

The composite score will be a combination of the decided weights and rating scales.

3. Modeling and analysis — in process

The Scientific Registry of Transplant Recipients (SRTR) will take proposed allocation policies and model them to determine the impact on candidates. These results will be produced in a report to help identify any potential unintended consequences or harmful outcomes for these example groups. These results will estimate the benefit of the new proposal and inform any needed improvements. The first modeling request was submitted to the SRTR in the spring of 2022. An October 2022 report was followed by an addendum in January 2023. The second modeling request was submitted to the SRTR in the spring of 2023, followed by a report in July 2023.

4. Public comment on policy proposal

This step will involve considering community input, modeling and analysis, and committee project work, as well as proposing a new composite score as a policy proposal for public comment.

  • Continuous distribution of kidney and pancreas proposal — to follow modeling and analysis

5. Board approval

The Board of Directors will review the proposal, OPTN and SRTR materials, and public comments, and consider the proposal in light of the requirements of the OPTN final rule. If the Board of Directors approves the proposal with the new framework, plans for implementation will begin.

  • Board briefing paper — to follow proposal

6. Implementation

Implementation of the policy for kidney and pancreas allocation is projected to take approximately 12 months due to the range of changes, required education to the community, and expected impact.

  • Policy notice — to follow board approval