Kidney Allocation System

On Dec. 4, 2014, the United Network for Organ Sharing (UNOS) and the Organ Procurement and Transplantation Network (OPTN) will enact a new approach to allocating kidneys to those on the transplant waiting list.

 

The current kidney matching system has helped tens of thousands of people successfully receive kidney transplants, but there were things that could be improved. Issues included some kidney recipients were not receiving kidneys that work as long as they needed them to, thus requiring re-transplantation at some point later in life. Another issue was that patients with difficult-to-match blood type or highly sensitive immune response were waiting significantly longer than other patients.

 

The new Kidney Allocation System (KAS) is the result of years of review and consensus-building among transplant professionals, patients and others personally connected to kidney donation and transplantation. They set out with one primary goal in mind: make the system better without making major changes to the parts of the system that worked well.

 

Kidney Allocation System Q&ADr. Clifford Miles

Presented by: Clifford Miles, M.D., UNOS Kidney Transplantation Committee Region 8 Representative; Assistant Professor of Internal Medicine; Transplant Nephrologist, University of Nebraska Medical Center

On Dec. 4, 2014, the United Network for Organ Sharing (UNOS) and the Organ Procurement and Transplantation Network (OPTN) implemented a new system for allocating deceased donor kidneys to those on the transplant waiting list. Questions have come in asking how the new Kidney Allocation System (KAS) will affect PKD patients. Join us for a conversation with Dr. Clifford Miles, UNOS Kidney Transplantation Committee Region 8 representative, where answers questions, both pre-submitted and submitted in real time, during the webinar.

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The KAS and the PKD Community

UNOS's new KAS aims to help more people have longer function with their transplanted kidney by matching the donated kidney that has the longest potential life with the recipient who has the longest potential life. Additionally, the KAS will give priority to groups of people who are hard to match based on blood type or immune sensitivity.

This system is will be beneficial to younger patients with ARPKD but may negatively impact patients who need transplants later in life, including ADPKD patients. Age is only one factor, however, and an individual in their 50's or 60's who are not diabetic and not on dialysis could be among the top candidates. This is why we encourage you to speak with your medical team to be referred to the transplant list early and, ideally, before starting dialysis. Read an article in our Fall 2014 issue of PKD Progress about the KAS.

KAS: What Every Candidate Needs to Know from UNOS

UNOS's new KAS training module is the latest available tool to help educate both transplant professionals and patients waiting for a kidney transplant about the upcoming changes. Both translations of the module are approximately 15 minutes long.

KAS FAQs

Click a question below to show or hide the answer.

How will kidneys be classified?

Every kidney offered for a transplant will be assigned a Kidney Donor Profile Index (KDPI) score - a percentage score that ranges from zero to 100. The score is associated with how long the kidney is likely to function as compared to other kidneys. A KDPI score of 20% means that the kidney is likely to function longer than 80% of other available kidneys. A KDPI score of 60% means that the kidney is likely to function longer than 40% of other available kidneys.

How is the KDPI Score Determined?

The KDPI is calculated based on many factors including:

  • Age
  • Height
  • Weight
  • Ethnicity
  • Cause of death
    • Loss of heart function
    • Loss of brain function
    • Stroke
  • History of high blood pressure
  • History of diabetes
  • Exposure to Hepatitis C
  • Serum creatinine

As a potential transplant recipient, how will I be classified?

Each transplant candidate will be assigned an individual Estimated Post-Transplant Survival (EPTS) Score – a percentage score from zero to 100. The score is based on how long the candidate will need a functioning kidney as compared to all other candidates. A person with an EPTS score of 20% is more likely to need a kidney longer than 80% of all other candidates. Someone with an EPTS of 60% will likely need a kidney longer than 40% of other candidates. Your transplant team will calculate your EPTS score for you.

What goes into an EPTS Score?

Your EPTS score is calculated based on many factors including:

  • Age
  • Length of time spent on dialysis
  • Previous transplant status (of any organ)
  • Current diagnosis of diabetes

How do the KDPI and EPTS scores allocate kidneys?

The 20 percent of kidneys expected to last the longest (those with a KDPI score of 20 percent or less) will first be offered to patients likely to need a transplant the longest (those with an EPTS of 20 percent or less). If a kidney with a KDPI of 20 percent or less is not accepted for any of these patients, it will then be offered to any other person who would match, regardless of their EPTS score.

Kidneys with high KDPI scores are expected to function for a shorter amount of time than others. They may be best used to help candidates who are less able to stay on dialysis for a long time.

What if I was already listed when the new KAS goes into effect?

If you were already listed, you do not need to be reevaluated or relisted. You may be contacted by your transplant program for information, but only to ensure everything is accurate in the system. You will not lose credit for any time you have already spent waiting. If you began dialysis before you were listed, your transplant waiting time will be backdated to your first dialysis date.

What do I do next?

If you are already on the transplant list, you don't need to do anything – it will be done for you. Talk to your transplant team to understand what your EPTS is and find out other details.

If you are not on the list but want to find out more information, the first thing to do is talk with your physician/nephrologist. You may need to bring this up – don't wait for them to ask you. It is important that you take a proactive role in your own health! Most transplant centers have criteria that you must meet before you can be evaluated for a transplant (certain eGFR levels, for example). This does not mean you can't meet with them and gather as much information as possible. The key to the new KAS for PKD patients is to get listed as early as possible – before dialysis begins – in order to get the lowest possible EPTS score.

Read the PKD Foundation's Scientific Advisory Committee position. The position was released in 2012 when UNOS announced proposed changes to the allocation policy.

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©2018, PKD Foundation ·The PKD Foundation is a 501 (c)(3), 509 (a)(1) public charity.

©2018, PKD Foundation ·The PKD Foundation is a 501 (c)(3), 509 (a)(1) public charity.