*Purpose: Multi-Organ Transplant (MOT) candidates involving a kidney receive higher allocation priority than kidney alone transplant (KAT) candidates. The increasing utilization of MOT has the potential to disadvantage patients requiring a KAT, and may undermine the objectives of the Kidney Allocation System. This study characterizes the KAT candidates potentially impacted by MOT candidate priority.

*Methods: Using the OPTN database, we identified all deceased donors from 2002-2017 who had one kidney used in a MOT and the other kidney used for a KAT (including kidney-pancreas; n = 7,378, median KDPI 28%). We evaluated kidney potential transplant recipient (PTR) data for these donors to identify the KAT candidate who was “next-in-line” based on the PTR sequence number, but who did not receive the kidney offer due to the MOT recipient’s higher priority. We compared characteristics of MOT recipients with next-in-line KAT candidates, and assessed subsequent waitlist outcomes of the next-in-line candidates.

*Results: Next-in-line KAT candidates were younger than MOT recipients and 9.9% of next-in-line candidates were pediatric. The majority of next-in-line candidates were racial minorities (54.1%), compared to 37.2% of MOT recipients. 54.4% of MOT recipients received pre-transplant dialysis versus 82.0% of next in line candidates, and median dialysis vintage at the time of offer was 4.6 years for next-in-line candidates and approximately 4 months for MOT recipients. HLA sensitization was more common in next-in-line candidates (35.5%) than MOT recipients (9.7%). 575 next-in-line candidates (7.8%) were highly sensitized (CPRA 98-100%). 62.1% of next-in-line candidates later received a KAT in the U.S. However, the kidneys eventually received were higher KDPI than the original next-in-line offer. Following the next-in-line offer, a substantial number of next-in-line transplant candidates, 2,084 (28.2%), died or were removed from the waiting list, having never been transplanted.

*Conclusions: Current MOT allocation priority may disadvantage patients awaiting a KAT, including subgroups prioritized by KAS such as highly sensitized and pediatric KAT candidates. While the majority of next-in-line candidates later receive a kidney transplant, a substantial number were not transplanted. To optimize equity and utility in organ allocation, prioritizing select KAT candidate subgroups (e.g. highly sensitized) above certain MOT candidates should be considered.

« Back to 2020 American Transplant Congress