New Insights Into the Alleged Kidney Donor Profile Index Labeling Effect on Kidney Utilization

Area of Science:

• Nephrology
• Transplantation Science
• Health Informatics

Background:

• The Kidney Donor Profile Index (KDPI) is crucial for deceased donor kidney allocation under the kidney allocation system (KAS).
• A significant programming error in DonorNet inflated KDPI values between April 20 and May 19, 2016.

Purpose of the Study:

• To assess the impact of erroneously high KDPI values on kidney discard rates and organ utilization.
• To determine if clinicians and patients relied heavily on KDPI for kidney acceptance decisions during the error period.

Main Methods:

• Analysis of kidney discard rates and recipient patterns during a 30-day period of incorrect KDPI reporting.
• Comparison of observed discard rates with pre-KAS averages, post-KAS averages, and projected rates based on KDPI.
• Risk-adjusted analyses to attribute changes in discard rates to KDPI inflation versus other factors.

Main Results:

• The observed kidney discard rate (22.9%) was higher than the post-KAS average (19.6%) but lower than projected (31.4%).
• Elevated discard rates were strongly linked to KDPI inflation, particularly for kidneys crossing the 85% policy threshold.
• Recipient distribution patterns largely mirrored pre-KAS trends, suggesting KDPI was not the sole decision-making factor.

Conclusions:

• Erroneously high KDPI values significantly increased kidney discard rates, especially for high-risk kidneys.
• Despite the KDPI error, organ utilization decisions were not solely dependent on this metric.
• The findings highlight the importance of accurate data in organ allocation systems and the multifactorial nature of kidney utilization decisions.