Background: Changes to the Kidney Allocation System (KAS) required transplant programs to utilize resources to prepare for its implementation. A complex strategy was developed which shifted programmatic operations to focus on verification and entry of the new required data fields. This report quantifies the personnel utilization and financial support required to comply with this single UNOS system change.

Methods: Beginning March 31, 2014, all listed patients were sequentially prioritized according to their ABO type, anticipated new ranking on the UNOS waiting list according to the aggregate of dialysis start data and/or activation date, and then scrutinized to obtain and verify all data for the new fields of dialysis start date, diabetes, and prior transplants.

Results: A total of 1,416 patients on our waiting list as of March 31, 2014 were reviewed: ABO A = 367; AB = 34; B =272; and O = 743. With 9 staff members, including RN and assistant administrative staff each working to verify the records of bundled groups of 10 patients each week, the process required approximately 2 hours/week for each staff member. In May, 2014, the addition of 2 data fields, previous transplants and diabetes, meant a second medical record review in order to confirm verification, adding an additional work burden to the transition process. An average of $625/week was utilized in RN and assistant salaries and fringe totaling $20,000 for the 32 week process, translating to 570 person hours diverted from direct patient care to purely administrative activities. Since the beginning of the review process, the waiting waiting list has grown to 1608 with 331 unverified records remaining.

Conclusion: The criteria for adherence to the UNOS KAS required a significant shift in programmatic resources. Although clinically relevant, the UNOS KAS change posed a significant unfunded burden, especially to programs with larger waiting lists. The transplant community must be mindful that even small changes to the organ allocation system can impact the overall cost of transplant care.

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