Efficiency and Utilization in Kidney and Pancreas Continuous Distribution Request for Feedback

At a glance

Background

This request for feedback builds upon the previous Kidney Transplantation and Pancreas Transplantation Committees’ papers on their continuous distribution projects. This paper requests community feedback on specific operational topics that will assist the Kidney and Pancreas Committee’s work.

Click the link for a closer look at Continuous Distribution: https://optn.transplant.hrsa.gov/policies-bylaws/a-closer-look/continuous-distribution/

Supporting media

Presentation

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Requested feedback

The community is asked to provide feedback on several operational topics and options to improve efficiency and utilization, including:
- Released Kidneys and Pancreata Allocation
- National Kidney Offers and Kidney Minimum Acceptance Criteria Screening
- Dual Kidney and En Bloc Allocation
- Facilitated Pancreas Allocation
- Mandatory Kidney-Pancreas Offers
- Considerations in Pancreas Medical Urgency

Project update

Since September 2020, the Kidney and Pancreas Transplantation Committees have been developing their continuous distribution projects simultaneously
There are multiple workgroups focusing on key areas of the project, including operational topics like dual kidney allocation and the creation of kidney and pancreas review boards
The Committees have reviewed the results from the first modeling request from the Scientific Registry of Transplant Recipients (SRTR), and have submitted a second modeling request in early 2023. The results are expected in Summer 2023.
The Committees will continue to update the community on this project’s progress

Project goals

Provide a more equitable approach to matching kidney and pancreas candidates and donors
Remove hard boundaries between classifications that prevent kidney and pancreas 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
Have a uniform system that will make future policy changes faster

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 and pancreas allocation in a continuous distribution framework
What it won't do
- This paper is not a proposed policy change, but is an update on the project

Terms to know

Dual Kidney Transplant: the transplant of two kidneys from one donor into one recipient
En Bloc Kidney Transplant: the transplant of two kidneys from one donor who weighs less than 18 kg into one recipient
Facilitated Pancreas Allocation: a screening tool used to speed up allocation of a pancreas by sending the offer only to programs who are nearby the donor hospital or otherwise have proven they will accept pancreata from far away with short notice
Kidney Minimum Acceptance Criteria Screening Tool (KiMAC): a screening tool used for kidney offers sent to transplant programs more than 250 nautical miles (NM) away from the donor hospital
National Kidney Offers: kidney offers sent to candidates at transplant programs more than 250 NM away from the donor hospital.
Organ Allocation Simulator (OASIM): The name for SRTR’s modeling for the continuous distribution allocation framework.
Released Organ: describes an organ that was previously accepted by a transplant program, but later declined after further evaluation of the organ at the hospital. The transplant program “releases” the organ back to the OPO to be placed with another candidate.