*Purpose: The OPTN implemented a policy on September 5, 2019 standardizing en bloc deceased donor kidney allocation in order to efficiently place and utilize kidneys from small donors. Kidneys recovered from donors weighing less than 18 kilograms are required to be offered en bloc. En bloc match runs follow the same algorithm used for KDPI 0-20% kidneys, as they have been shown to have comparable outcomes. Pediatric and low EPTS candidates were expected to have increased access to en bloc transplants as a result of this change.

*Methods: We queried the OPTN database for en bloc deceased donor kidney transplants performed between September 5, 2018 and August 4, 2020. Counts and percent of transplants were compared by EPTS pre- versus post-policy implementation.

*Results: There were 210 en bloc deceased donor kidney transplants in the year prior to policy implementation, and 166 in the eleven months following implementation. The proportion of en bloc transplants to EPTS 0-20% recipients more than doubled from 29.5% pre-policy to 75.5% post-policy (Figure 1). The proportion of pediatric recipients of en bloc transplants also increased from 0.5% to 1.2%, though this reflected a change of one transplant.

*Conclusions: In addition to standardizing en bloc kidney allocation nationally, this policy change directed kidneys with good expected outcomes to patients expected to maximize the longevity of the organ. The OPTN Kidney Committee will continue to monitor its impact.

Figure 1: En Bloc Kidney Transplants by EPTS and Policy Era

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