Increasing Utilization via Accelerating the Placement of Hard-to-Place Kidneys

S. Noreen¹, R. Brown¹, Y. Becker², M. Cooper³, K. O'Connor⁴, J. Prinz⁵, D. Klassen¹

¹United Network for Organ Sharing, Richmond, VA, ²University of Chicago Medical Center, Chicago, IL, ³MedStar Georgetown Transplant Institute, Washington, DC, ⁴LifeCenter Northwest, Bellevue, WA, ⁵Donor Alliance, Denver, CO

Meeting: 2020 American Transplant Congress

Abstract number: 234

Keywords: Allocation, Donors, marginal, High-risk, Kidney

Session Information

Session Name: Kidney Deceased Donor Allocation II

Session Type: Oral Abstract Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:45pm

Presentation Time: 4:03pm-4:15pm

Location: Virtual

*Purpose: Increasing the number of transplants by increasing utilization is a key goal of the OPTN, with a particular focus on the use of marginal kidneys in recent years. The United Network for Organ Sharing (UNOS) Organ Center has recently undertaken a project to accelerate the placement of so-called hard-to-place kidneys, defined as kidneys from donors with a KDPI of ≥80 and rejected both locally and regionally.

*Methods: Match runs for adult donors with KDPI ≥80 at time of allocation between April 17, 2019 and October 16, 2019 were reviewed. The kidney accelerated placement (KAP) project was implemented on July 18, 2019 with offers made by the UNOS Organ Center. Similar allocations from April 17 through July 16, were defined as the pre-KAP project period and used for comparison purposes.

*Results: Following implementation of KAP, a 45% increase in kidney acceptance of KDPI ≥80 compared to the pre-KAP period was recognized. Additionally, a higher rate of conversion from acceptance to transplant was also appreciated (Table 1). The recipients of these accepted hard-to-match kidneys are more often the intended candidate (63.3% of transplants during KAP compared to 57.7% during the prior period), rather than another candidate at the accepting center, reinforcing that these offers are not seen as “open offers”. The phenotype of kidney programs accepting these hard-to-place kidneys are considerably more aggressive, with larger waiting lists and a history of higher than expected acceptance of high KDRI and >100 offer donors (Table 2).

*Conclusions: Despite a small sample size, the KAP project has exhibited several encouraging trends in these early results. Utilizing programs’ previous acceptance patterns and designing an allocation scheme that allows these hard to place kidneys to reach those programs likely, and with the resources, to safely and successfully say ‘yes’, has resulted in an observable increase in allograft placement and transplant. Ongoing review of data to further support this pilot is ongoing.

Table 1. KAP-related acceptances by transplant outcome and time period
	Pre-KAP time period	KAP time period
Transplanted	26 (53.1%)	49 (69.0%)
Not Transplanted	23 (46.9%)	22 (31.0%)
Total	49 (100%)	71 (100%)

Table 2. Comparison of programs with and without KAP-related acceptances, KAP time period
	Programs with KAP-related acceptances (N=29)	Programs without KAP-related acceptances (N=236)
2018 Year-end waitlist volume	557 [249, 931]	238 [110, 578]
Observed:Expected deceased donor transplant ratio	1.26 [0.73, 2.02]	0.97 [0.66, 1.32]
Observed:Expected offer acceptance ratio	1.73 [1.30, 2.88]	0.88 [0.63, 1.29]
Observed:Expected offer acceptance ratio – donors KDRI > 1.75	2.22 [1.33, 2.98]	0.66 [0.42, 1.10]
Observed:Expected offer acceptance ratio – donors > 100 offers	2.67 [1.00, 6.93]	0.56 [0.34, 0.99]
^{ Median and IQR shown.}*

To cite this abstract in AMA style:

Noreen S, Brown R, Becker Y, Cooper M, O'Connor K, Prinz J, Klassen D. Increasing Utilization via Accelerating the Placement of Hard-to-Place Kidneys [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/increasing-utilization-via-accelerating-the-placement-of-hard-to-place-kidneys/. Accessed May 16, 2025.

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