Kidney Accelerated Placement Project aims to improve transfer of hard-to-place kidneys
Thursday, January 09, 2020
The Organ Procurement and Transplantation Network (OPTN) launched the Kidney Accelerated Placement Project (KAPP) on July 18, 2019. The goal of the project is to assess whether speeding up the placement of hard-to-place kidneys could increase utilization of these organs.
OPTN developed this pilot testing program to improve placement of kidneys in response to the Executive Order on Advancing American Kidney Health and on feedback from the community.
“Hard-to-place” kidneys have a kidney donor profile index (KDPI) of 80 or higher and are offered to all transplant programs at both the local and regional level.
KAPP reflects recommendations outlined in the October 2018 National Kidney Foundation report, “Report of National Kidney Foundation Consensus Conference to Decrease Kidney Discards,” published in the journal Clinical Transplantation, the Journal of Clinical and Translational Research. The report focuses on reducing kidney discards and is the first to provide a systematic nationwide approach to decreasing the number of discarded kidneys.
The National Kidney Foundation report lists several reasons for discarded kidneys, such as poor organ quality, prolonged cold ischemic time, abnormal biopsy findings, anatomy, and increased costs of using higher kidney donor profile index (KDPI) grafts. However, data supports the use of many of these kidneys for transplant. Furthermore, kidney discard rates often vary by geography, which leads many experts to believe that variations in kidney discard rates may be the result of subjective views of organ viability on the part of individual transplant teams.
OPTN is testing accelerated placement of hard-to-place kidneys on allocations coordinated by the United Network for Organ Sharing (UNOS) Organ Center. Current OPTN policy requires that all organ procurement organizations (OPOs) transfer kidney matches for national allocation to UNOS Organ Center. KAPP will not require a change to this policy and affect only hard-to-place kidneys that UNOS already offers.
KAPP’s goal is to transplant more of these kidneys by having UNOS offer the organs to transplant centers that have accepted and transplanted medically similar kidneys in the past. If these transplant centers turn down the organ, UNOS Organ Center may extend the offer to other hospitals.
UNOS is updating qualifying acceptance patterns monthly. Members of a safety and monitoring council comprised of physicians and OPO executives is monitoring this data to determine if KAPP is resulting in more effective placement of hard-to-place kidneys.
The council monitors outcomes and discards in real time, regularly evaluates the structure of the pilot program, and will create recommendations for consideration by the OPTN Board of Directors at the end of the pilot in 2020. The council is developing criteria that will trigger an early end to the project if outcomes on national kidney offer acceptance do not meet expectations.
Transplant hospitals across the country will continue to receive national kidney offers throughout the testing period, and these institutions have the option to accept or decline these hard-to-place kidneys. The kidney accelerated placement test does not change OPO practices either, as OPTN already requires them to turn over organ allocation to UNOS Organ Center.
The council will look at the transplant program’s history of transplanting kidneys with similar or riskier donor characteristics from the prior two years. The data will refresh monthly to account for changes in kidney transplant characteristics.
Donor characteristics used in determining accelerated placement transplant programs are transplants from donors with similar or riskier donor KDPI, peak serum creatinine, age, history of diabetes or of IV drug use, and donation after circulatory death status.
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