Update on Continuous Distribution of Kidneys and Pancreata

At a glance

Background

In December 2018, the OPTN Board of Directors approved the continuous distribution framework for allocation of all organs. Continuous distribution will rank waiting list candidates based on points related to various factors, such as medical urgency, post-transplant survival, candidate biology, patient access, and placement efficiency. Continuous distribution will remove the hard boundaries built into the current framework to increase equity for patients and transparency in the system.

This concept paper provides an overview of the project’s development process and progress, and offers next steps for continuous distribution of kidneys and pancreata. The paper also requests community feedback that will assist the Kidney and Pancreas Committees’ work.

Supporting media

Presentation

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Progress so far

• From September 2020 – January 2021, the Kidney-Pancreas Continuous Distribution Workgroup worked to identify goals and key attributes related to kidney and pancreas transplantation.

Proposed concept

• Continuous distribution will replace the current classification-based allocation system with a points-based allocation system. A points-based framework assigns a composite allocation score to each candidate.
• A candidate’s composite allocation score will determine the order that organs are offered to candidates. 
• A candidate’s composite allocation score will consider a combination of donor and candidate characteristics including candidate medical urgency, post-transplant survival, candidate biology, patient access, and placement efficiency.

Anticipated impact

• What it's expected to do
  • Provide a more equitable approach to matching candidates and donors.
  • Remove hard boundaries that prevent candidates from being prioritized higher on the match run
  • Establish a system that is flexible enough to work for each organ type
• What it won't do
  • This paper is not a proposed policy change, but will help the Kidney and Pancreas Committees develop a future policy proposal.

Themes

• Proposed attributes for the composite allocation score
• Additional attributes that should be included
• Weight of attributes in final composite allocation score
• Best ways to convert current system into points-based framework

Terms to know

• Attribute: Attributes are criteria we use 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: A composite allocation score combines points from multiple attributes together. This concept paper proposes the use of composite allocation scores in a points-based framework.
• Rating Scale: A rating scale describes how much preference is given to candidates within each attribute.
• Weights: 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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