The Impact of Changes in OPTN Oversight of Kidney Programs on Organ Yield and Offer Acceptance Practices

A. Wey¹, N. Salkowski¹, B. Carrico², S. Sheppard², B. Kasiske¹, B. Thompson¹, A. Israni¹, J. Snyder¹

¹SRTR, Minneapolis, MN, ²OPTN, Richmond, VA

Meeting: 2019 American Transplant Congress

Abstract number: D26

Keywords: Allocation, Donors, marginal, Public policy, Risk factors

Session Information

Session Name: Poster Session D: Quality Assurance Process Improvement & Regulatory Issues

Session Type: Poster Session

Date: Tuesday, June 4, 2019

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall C & D

*Purpose: In March 2017, the Membership and Professional Standards Committee (MPSC) of the Organ Procurement and Transplantation Network implemented an operational rule to increase the number of kidney transplants from donors with kidney donor profile index (KDPI) ≥85% into recipients with estimated posttransplant survival (EPTS) ≥80%. The operational rule aimed to increase transplants by reducing disincentives associated with regulatory review by removing kidney transplants with KDPI ≥85% and EPTS ≥80% from MPSC flagging criteria.

*Methods: We investigated the effect of the operational rule on (1) the number of kidneys transplanted per recovered donor (i.e., kidney yield), and (2) offer acceptance practices. An ordinal logistic regression estimated the difference in kidney yield before and after implementation after adjusting for donor factors. Similarly, a logistic regression estimated the difference in deceased donor offer acceptance practices before and after implementation for kidney-alone candidates after adjusting for candidate and donor factors.

*Results: Both analyses used donors recovered January 1, 2016-February 28, 2018. Kidney yield for donors with KDPI ≥85% was significantly higher after than before implementation (odds ratio [OR], _1.111.27_1.46), although yield was also significantly higher for donors with KDPI <85% (OR, _1.071.16_1.26). Similarly, offer acceptance for donors with kidney donor risk index (KDRI) ≥1.75 (approximately KDPI of 85%) was higher (OR, _0.961.04_1.13), although the increase was similar for donors with KDRI <1.75 (OR, _1.021.05_1.08).

*Conclusions: The MPSC operational rule may have increased kidney yield, although lack of a control group and increased yield for donors unaffected by the rule significantly complicate the results.

Table 1: Odds ratio for difference in kidney yield before and after implementation of the operation rule, March 1, 2017. (KDPI ≥85% kidneys estimated 27% higher odds of placement after implementation.)

Table 1
Category	Odds Ratio	95% Confidence Interval
KDPI <85%	1.16	(1.07-1.26)
KDPI ≥85%	1.27	(1.11-1.46)

Table 2. Odds ratio for difference in the acceptance of deceased donor kidney offers before and after implementation of the operational rule, March 1, 2017.

Table 2
Category	Odds Ratio	95% Confidence Interval
KDRI <1.75	1.05	(1.02-1.08)
KDRI ≥1.75	1.04	(0.96-1.13)

To cite this abstract in AMA style:

Wey A, Salkowski N, Carrico B, Sheppard S, Kasiske B, Thompson B, Israni A, Snyder J. The Impact of Changes in OPTN Oversight of Kidney Programs on Organ Yield and Offer Acceptance Practices [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/the-impact-of-changes-in-optn-oversight-of-kidney-programs-on-organ-yield-and-offer-acceptance-practices/. Accessed November 22, 2024.

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