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Continuous Distribution of Kidneys, Winter 2025

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Current policy

This paper builds upon the Kidney Transplantation Committee’s previous request for feedback on the Committee’s Continuous Distribution (CD) updates. This update provides the Committee’s progress to date on the continuous distribution project, including their continued discussions on efficiency objectives, including reducing non-use of kidneys, reducing out of sequence allocation for kidneys, establishing a definition for “hard to place” kidneys, and consideration of an expedited placement pathway in the continuous distribution of kidneys. This update also includes Committee discussions on continued modeling and optimization.

Supporting Media

Presentation

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Project update

  • The Committee continues working with the Scientific Registry of Transplant Recipients (SRTR) and the Massachusetts Institute of Technology (MIT) on more detailed modeling capabilities for kidney non-use and allocation efficiency
  • The Committee is also working to develop a data-driven definition of “hard to place” kidneys
  • Additionally, this update details the efforts of the Kidney Expedited Placement Workgroup, which is working towards developing an expedited kidney placement policy

Project goals

  • Provide a more equitable approach to matching kidney candidates and donors
  • Remove hard boundaries between classifications that prevent kidney candidates from being prioritized further on the match run
  • Consider multiple patient attributes simultaneously through a composite allocation score instead of within categories
  • Establish a system that is flexible enough to work for each organ type
  • Create a uniform system that will make future policy changes faster
  • Consider how CD would impact the goals of decreasing non-use and non-utilization of kidneys

Anticipated impact

  • What it's expected to do
    • Prioritize candidates in a more flexible manner
    • Allow the transplant community to see how much weight is placed on each attribute
    • Improve equity in access to organ transplantation
    • Improve efficiency of kidney allocation in a continuous distribution framework
  • What it won't do
    • This paper is not a proposed policy change at this time, but is an update on the project

Terms to know

  • Attribute: Criteria used to classify then sort and prioritize candidates. For example, in kidney allocation, criteria include medical urgency, blood type compatibility, HLA matching, and others.
  • Composite Allocation Score: Combines points from multiple attributes together. This concept paper proposes the use of composite allocation scores in a points-based framework.
  • Match Run: The list of potential recipients printed by the OPO or Organ Center for each organ recovered for the purpose of transplantation from each donor.
  • Modeling: Calculations the Scientific Registry of Transplant Recipients (SRTR) uses to create model predictions on the different attributes and their effect on organ allocation.
  • Rating Scale: Describes how much preference is given to candidates within each attribute.
  • Weights: Reflect the relative importance or priority of each attribute toward our overall goal of organ allocation. Combined with the ratings scale and each candidate’s information, this results in an overall composite score for prioritizing candidates.

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Read the full proposal (PDF)

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