Establish Minimum Kidney Donor Criteria to Require Biopsy

At a glance

Current policy

Procurement kidney biopsies are a tool that OPOs and transplant doctors use to assess a deceased organ donor’s kidney for organ damage and potential kidney function. Over the years, kidney biopsies have become more widely used, but their usage varies greatly across the country. Currently, OPTN policy does not set a minimum standard for when a kidney biopsy must be performed.

Supporting media

Presentation

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Proposed changes

• OPOs will be required to perform a kidney biopsy on deceased organ donors who meet any of the following, excluding donors less than 18 years old:
  • Urine output of less than 100ml in 24 hours
  • Donor has received hemodialysis or other renal replacement therapy either during most recent hospital admission or in the course of donor management
  • History of diabetes, including a hemoglobin A1c of 6.5 or greater during donor evaluation and management
  • KDPI greater than 85%
  • Donor age 60 years old or greater
  • Donor age 50-59, and meets at least two of the following criteria:
    • History of hypertension
    • Manner of death: Cerebrovascular Accident
    • Terminal creatinine of 1.5 mg/dL or greater

Anticipated impact

• What it's expected to do
  • Standardize kidney biopsy usage
  • Streamline communication between OPOs and transplant hospitals
  • Improve kidney allocation efficiency
• What it won't do
  • It will not limit when an OPO can perform a kidney biopsy including when a deceased organ donor does not meet the minimum criteria.

Terms to know

• Biopsy: a tissue sample from the body, removed and examined under a microscope to diagnose for disease, determine organ rejection, or assess donated organs or tissues.
• KDPI: Kidney Donor Profile Index, a mathematical system used to classify deceased donors to help improve kidney allocation efficiency.
• Hemoglobin A1c: a test used by medical professionals to assess pancreas function. A high hemoglobin A1c may be an indicator of diabetes in a patient.

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