Finalized change to OPTN calculation for deceased donor kidneys is a win for health equity

The Organ Procurement and Transplantation Network's (OPTN) Board of Directors recently took an important step in advancing health equity efforts, increasing access to transplant organs by approving a change to a calculation that summarizes the quality of deceased donor kidneys called the Kidney Donor Profile Index (KDPI). The American Kidney Fund (AKF) submitted a comment in support of this change during the public comment period and we applaud the OPTN for finalizing it. 

Here is what you need to know about the change and why it is important for people waiting for a kidney transplant.

What is the OPTN?

The OPTN is the public-private partnership that establishes and maintains policies and operational rules for the U.S. transplant system through its Board of Directors and working committees. The OPTN includes the U.S. Department of Health and Human Services, the OPTN contractor, transplant hospitals, organ procurement organizations, kidney organizations, medical professionals and members of the general public. 

What is the KDPI and what is the approved change? 

The Kidney Donor Profile Index (KDPI) is a measure that combines deceased donor factors, including clinical information and demographics, to summarize the quality of deceased donor kidneys into a single number. Kidney transplant clinicians often rely on the KDPI to inform their decision of whether to accept a kidney offer for their patient. A lower KDPI score means a kidney is estimated to function for a longer amount of time while a higher score is associated with a shorter amount of organ function time. 

Under the previous policy, the KDPI calculation included variables for race and if a deceased donor had the Hepatitis C virus (HCV). Therefore, kidneys from Black and HCV-positive deceased donors had an increased KDPI, making them appear less suitable for transplant. Earlier this year, the OPTN Minority Affairs Committee proposed the now-approved change that removes these race and HCV donor factors from the KDPI calculation. This change better reflects the likelihood of graft failure for kidneys from Black and HCV-positive donors.

Why is this change important?

As the OPTN Minority Affairs Committee explained in their reasoning, race is a poor proxy for human genetic variation because it is a social construct that lacks biological meaning. Additionally, the use of groundbreaking treatments for HCV has revolutionized HCV management, and now post-transplant outcomes for HCV-positive deceased donors are similar to those of HCV-negative donor kidneys.  Under the previous policy, kidneys from Black and HCV-positive deceased donors had an increased KDPI of up to 20% for each factor. Removing race and HCV donor factors from the KDPI calculation is a much-needed step in improving equity in access to transplant for candidates from these populations. 

While Black people make up 13% of the population, they account for more than 30% of kidney failure patients on the national waiting list. In terms of the waiting time for a kidney, 41% of Black patients were still waitlisted for a kidney three years after initially being placed on the waitlist. In comparison, 26% of white patients were still waitlisted for a kidney three years after initial waitlisting. Since Black patients are more likely to receive kidneys from Black donors, removing race from KDPI could help to decrease the waiting time disparity for Black transplant candidates and increase the number of organs from Black deceased donors that are used.