Table 1.

Overview of the new kidney allocation policy, based on the KDPIa and EPTSb

Wait-Listed Candidates
KDPI≤0.20KDPI 0.21–0.34KDPI 0.35–0.85KDPI>0.85
Local CPRA 100%Local CPRA 100%Local CPRA 100%Local CPRA 100%
Regional CPRA 100%Regional CPRA 100%Regional CPRA 100%Regional CPRA 100%
National CPRA 100%National CPRA 100%National CPRA 100%National CPRA 100%
Local CPRA 99%Local CPRA 99%Local CPRA 99%Local CPRA 99%
Regional CPRA 99%Regional CPRA 99%Regional CPRA 99%Regional CPRA 99%
Local CPRA 98%Local CPRA 98%Local CPRA 98%Local CPRA 98%
0 HLA mm top 200 HLA mm0 HLA mm0 HLA mm
Prior living donorsPrior living donorsPrior living donorsLocal, regional adult
Local pediatricLocal pediatricLocalNational adult
Local top 20Local adultRegional
0 HLA mm bottom 80Regional pediatricNational
Local bottom 80Regional adult
Regional pediatricNational pediatric
Regional top 20National adult
Regional bottom 80
National pediatric
National top 20
National bottom 80
  • 0 HLA mm designates candidates with zero HLA mismatch at A, B, and DR loci; top 20 designates candidates in the top 20th percentile of survival; bottom 80 designates candidates not in the top 20th percentile of survival. Both the new and the current allocation policies give priority to candidates listed for simultaneous kidney and non-kidney organ transplants, including kidney-pancreas, kidney-liver, and kidney-heart transplants. This is not shown in the table above and is not included in the KPSAM modeling. Prior living donors represent a small number of candidates who are not included in the KPSAM modeling. SCr, serum creatinine; CVA, cerebrovascular accident.

  • a KDPI is derived from the kidney donor risk index (KDRI) developed by Rao et al.7 The KDPI includes only the donor-specific elements of the KDRI, and is mapped to a reference population from the previous year, in order to yield percentiles. For KDRI, the reference population is all kidneys recovered for transplant between January 1, 2007, and December 31, 2009. The calculation is as follows: KDRI=exp(−0.0194×I[age<18 yr]×[age−18 yr]+0.0128×[age−40 yr]+0.0107×I[age>50 yr]+0.179×I[race=African American]+0.126×I [hypertensive]+0.130×I[diabetic]+0.220×[SCr−1 mg/dl] −0.209×I[SCr>1.5 mg/dl]×[SCr−1.5 mg/dl]+0.0881×I[cause of death=CVA]−0.0464×[{height−170 cm}/10]−0.0199×I[weight<80 kg]×[{weight–80 kg}/5]+0.133×I[donation after cardiac death] +0.240×I[hepatitis C]−0.0766, where I is equal to 1 if the condition is true and I is equal to 0 if the condition is false.

  • b EPTS score=0.047×MAX (Age−25, 0)−0.015×Diabetes×MAX(Age–25,0)+0.398×Prior Organ Transplant−0.237×Diabetes×Prior Organ Transplant+0.315×log(Years on Dialysis+1)−0.099×Diabetes×log(Years on Dialysis+1)+0.130×(Years on Dialysis=0)−0.348×Diabetes×(Years on Dialysis=0)+1.262×Diabetes.