The revised Kidney Allocation System (KAS) has been operational for 3 years. The bolus effects seen early following the introduction have abated and a steady state has been achieved. Previous reports have shown an increase in regional and national sharing and no change in 1 year death censored overall graft survival. KAS implemented 4 allocation sequences based on KDPI, a calculated risk index used as a predictor of long term outcome. KAS prioritized the top 20% most optimal donor organs (Sequence (S) A) to candidates with the greatest estimated post-transplant (tx) survival (EPTS)(0-20)) and S-A plus S-B (KDPI 21-35%) organs to pediatric candidates. Since KAS, data review shows a decrease in the rate of pediatric transplants and a failure to maximally allocate the S-A kidneys to the best EPTS candidates. Current UNOS policy requires the kidney be allocated to a M-O candidate before passing into the kidney alone KAS prioritization.

Of the 14084 total kidneys available for tx in KAS Year 2, 11.7% were never allocated according to the KAS algorithm. Based on the previously reported M-O distribution in 2015, 87.2% of SPK, 53.4% of SLK and 70.6% of K+O candidates received the most optimal (and pediatric prioritized) S-A + S-B donor organs and never allocated to pediatric recipients. Also bypassed for these optimal kidneys were the KAS stratified highly sensitized, prior living donor and greatest EPTS candidates. Additionally, with the exception of the SLK recipients, there are no outcomes reporting required for the other 855 kidneys.

Under current UNOS policy M-O tx recipients receive prioritization for 11.7% of the most optimal kidney before kidney tx alone allocation thus disadvantaging multiple vulnerable populations, including pediatrics. Efforts to optimize the intended benefits of KAS would promote the principles of longevity matching and fairness in kidney allocation. Policy correction of this growing problem is indicated.

CITATION INFORMATION: Aeder M., Turgeon N. Multi-Organ (M-O) Prioritization of Kidneys: ? Time for Policy Modification Am J Transplant. 2017;17 (suppl 3).

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