the deceased donor kidney allocation system. 123,208 organ tx candidates are on the waiting list...
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The Deceased Donor Kidney Allocation System
123,208 organ tx candidates are on the waiting list
101,603 are waiting for a kidney tx
As of February 15…
Waiting time calculation
• Pre-registration dialysis time added
Candidate classification
• Estimated Post Transplant Survival Score (EPTS)
Kidney donor classification
• Replace SCD/ECD with Kidney Donor Profile Index (KDPI)
Overall Changes to Allocation System
Recent Allocation Component Changes
Priority for sensitized
candidates
• Calculated panel reactive antibody (CPRA) sliding scale, regional/national sharing for CPRA greater than 98%
Pediatric kidney
allocation• KDPI priority
Blood type eligibility
• A2 and A2B to B compatible
Kidney candidate
priority
Priority points
Match classification (position on
the match run)
Candidate Priority
Sequence AKDPI <=20%
Sequence BKDPI >20% but
<35%
Sequence CKDPI >=35% but
<=85%
Sequence DKDPI>85%
Highly Sensitized0-ABDRmm (top 20% EPTS)Prior living donorLocal pediatricsLocal top 20% EPTS0-ABDRmm (all)Local (all)Regional pediatricsRegional (top 20%)Regional (all)National pediatricsNational (top 20%)National (all)
Highly Sensitized0-ABDRmmPrior living donorLocal pediatricsLocal adultsRegional pediatricsRegional adultsNational pediatricsNational adults
Highly Sensitized0-ABDRmmPrior living donorLocal RegionalNational
Highly Sensitized0-ABDRmmLocal + Regional National
Waiting Time Points
Dialysis start date
Date after registration that eGFR is at or
below 20 mL/mn
Waiting Time Points Priority
*Peds begin accruing waiting time at listing regardless of clinical factors
Waiting Time QualifiersDialysis• Determined by listing center• Waittime may start prior to listing• Multiple centers may have equal waittime points• Acceptable methods of documentation
• 2728, dialysis center letter, physician note
GFR/Cr Clearance• Determined by listing center• Waittime can only start at or after candidate is listed• Only one center can have longest waittime points• Acceptable methods of documentation
• Laboratory
Multiple DSAs listingAccess to different local donor poolCompleting with different candidates
Multiple local listingsAlternate clinical interventions availableDifferent acceptance rates and parameters
Multiple Listing with Dialysis as the Waittime Qualifer
Estimated Post Transplant Survival
EPTS score range 0%-100%
Time on dialysis
Candidate’s age
Any prior solid organ
transplant
Current diagnosis
of diabetes
EPTS Match Classification Priority
EPTS score used to identify two groups of patients*
Those with scores of 0-20%
Those with scores of 21-100%
*The top 20% EPTS is calculated based on a national pool of candidates from a certain time period.
Kidney Donor Profile Index
KDPI based on:
Donor age
Height
Weight
Ethnicity
History of hypertension
History of diabetes
Cause of death
Serum creatinine
Hepatitis C virus status
Donation after circulatory death
• KDPI scores range from 0-100%• Lower KDPI is associated with better
longevity
Using the KDPI to Predict Graft Survival
EPTS & KDPI in the New System
Longevity MatchingEPTS0-20%
KDPI0-20%
Candidate Points Report
National 20% EPTS
OHOU Blood Type O candidates 48 candidates that fall within the 20%
Sequence AKDPI <=20%
Sequence BKDPI >20% but
<35%
Sequence CKDPI >=35% but
<=85%
Sequence DKDPI>85%
Highly Sensitized0-ABDRmm (top 20% EPTS)Prior living donorLocal pediatricsLocal top 20% EPTS0-ABDRmm (all)Local (all)Regional pediatricsRegional (top 20%)Regional (all)National pediatricsNational (top 20%)National (all)
Highly Sensitized0-ABDRmmPrior living donorLocal pediatricsLocal adultsRegional pediatricsRegional adultsNational pediatricsNational adults
Highly Sensitized0-ABDRmmPrior living donorLocal RegionalNational
Highly Sensitized0-ABDRmmLocal + Regional National
Sequence AKDPI <= 20%
Highly Sensitized (CPRA 98+)
0-ABDRmm (0-20% EPTS)
Prior living donor
Local pediatrics
Local (0-20% EPTS)
0-ABDRmm (21-100% EPTS)
Local (21-100% EPTS)
Regional Pediatrics
Regional (0-20% EPTS)
Regional (21-100% EPTS)
National Pediatrics
National (0-20% EPTS)
National (21-100% EPTS)
Based on unacceptable antigens listed for the candidate
Used to calculate how many donors will be incompatible with the candidate
Ranges from 0-100%
CPRA score
CPRA Priority Points
CPRA
0 0 0 0.08 0.21 0.34 0.48 0.81 1.091.58 2.46
4.05
6.71
10.82
12.17
17.30
02468
101214161820
0 10 20 30 40 50 60 70 80 90 100
Po
ints
CPRA Sliding Scale (Allocation Points)(CPRA<98%)
CPRA
CPRA Match Classification PrioritySequence A
KDPI <=20%Sequence BKDPI >20% but
<35%
Sequence CKDPI >=35% but
<=85%
Sequence DKDPI>85%
Highly Sensitized0-ABDRmm (top 20% EPTS)Prior living donorLocal pediatricsLocal top 20% EPTS0-ABDRmm (all)Local (all)Regional pediatricsRegional (top 20%)Regional (all)National pediatricsNational (top 20%)National (all)
Highly Sensitized0-ABDRmmPrior living donorLocal pediatricsLocal adultsRegional pediatricsRegional adultsNational pediatricsNational adults
Highly Sensitized0-ABDRmmPrior living donorLocal RegionalNational
Highly Sensitized0-ABDRmmLocal + Regional National
CPRA greater than 98%
Aged 0-10 at the time of the match run and 0-ABDR
mismatch with donor = 4 points
Aged 0-10 at the time of the match run and the donor’s
KDPI is less than 35% = 1 point
Aged 11-17 at time of the match run and a 0-ABDR
mismatch with donor = 3 points
Pediatric Status Points
Pediatric Match Classification Priority
Sequence AKDPI <=20%
Sequence BKDPI >20% but
<35%
Sequence CKDPI >=35% but
<=85%
Sequence DKDPI>85%
Highly Sensitized0-ABDRmm (top 20% EPTS)Prior living donorLocal pediatricsLocal top 20% EPTS0-ABDRmm (all)Local (all)Regional pediatricsRegional (top 20%)Regional (all)National pediatricsNational (top 20%)National (all)
Highly Sensitized0-ABDRmmPrior living donorLocal pediatricsLocal adultsRegional pedsRegional adultsNational pediatricsNational adults
Highly Sensitized0-ABDRmmPrior living donorLocal RegionalNational
Highly Sensitized0-ABDRmmLocal + Regional National
*Pediatric match classification priority is based on age at the time of registration (not time of the match run)
4 points with every registration
Prior Living Organ Donors
Sequence AKDPI <=20%
Sequence BKDPI >20% but
<35%
Sequence CKDPI >=35% but
<=85%
Sequence DKDPI>85%
Highly Sensitized0-ABDRmm (top 20% EPTS)Prior living donorLocal pediatricsLocal top 20% EPTS0-ABDRmm (all)Local (all)Regional pediatricsRegional (top 20%)Regional (all)National pediatricsNational (top 20%)National (all)
Highly Sensitized0-ABDRmmPrior living donorLocal pediatricsLocal adultsRegional pediatricsRegional adultsNational pediatricsNational adults
Highly Sensitized0-ABDRmmPrior living donorLocal RegionalNational
Highly Sensitized0-ABDRmmLocal + Regional National
A zero HLA-DR mismatch with the
donor = 2 points
A single HLA-DR mismatch with the
donor = 1 point
HLA-DR matching priority points
HLA Match Classification Priority
Sequence AKDPI <=20%
Sequence BKDPI >20% but
<35%
Sequence CKDPI >=35% but
<=85%
Sequence DKDPI>85%
Highly Sensitized0-ABDRmm (top 20% EPTS)Prior living donorLocal pediatricsLocal top 20% EPTS0-ABDRmm (all)Local (all)Regional pediatricsRegional (top 20%)Regional (all)National pediatricsNational (top 20%)National (all)
Highly Sensitized0-ABDRmmPrior living donorLocal pediatricsLocal adultsRegional pediatricsRegional adultsNational pediatricsNational adults
Highly Sensitized0-ABDRmmPrior living donorLocal RegionalNational
Highly Sensitized0-ABDRmmLocal + Regional National
Rank-ordering of Candidates within each Match Classification
Total points determined by:Waiting time CPRA sliding scale
HLA-DR matching Pediatric status
Prior living donor status
Tiebreaker = date of registration
Transplant Pro Resources
Example of Resources