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Updating the kidney donor risk index: Removing donor race and hepatitis C virus status
Jonathan M Miller1, Kelley Poff2, Jesse N Howell2
1Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA.
Insights
Removing donor race and hepatitis C virus (HCV) status from the kidney donor risk index (KDRI) formula promotes more equitable kidney transplant allocations. This update ensures fairer kidney donor profile index (KDPI) distributions for all races.
Area of Science:
- Nephrology
- Transplantation Science
- Public Health
Background:
- The Kidney Donor Risk Index (KDRI) is crucial for organ allocation, but concerns exist regarding its use of donor race and hepatitis C virus (HCV) status.
- The Organ Procurement and Transplantation Network's Minority Affairs Committee requested a review to assess the impact of these variables on equity.
Purpose of the Study:
- To recalculate the KDRI formula excluding donor race and HCV status.
- To evaluate the impact of removing these variables on kidney donor profile index (KDPI) distributions and racial equity.
Main Methods:
- A revised KDRI model was developed using data from adult, deceased donor, solitary kidney, first-time transplants between 2018-2021.
- A counterfactual analysis was performed on deceased donors (2018-2021) to compare KDPI under the original and revised models.
Main Results:
- The coefficient for Black race in the KDRI model decreased slightly (0.18 to 0.15), while the coefficient for HCV seropositivity decreased substantially (0.24 to -0.04).
- Excluding race and HCV status led to an increased probability of Black donors being classified with KDPI ≤20% and a notable decrease in the probability of being classified as KDPI >85%.
Conclusions:
- Removing donor race and HCV status variables from the KDRI formula results in more racially equitable KDPI distributions.
- This modification enhances fairness in kidney allocation by mitigating potential biases associated with donor characteristics.
Abstract:
This study reports the results of a recalculation of the kidney donor risk index (KDRI) formula requested by the Organ Procurement and Transplantation Network's Minority Affairs Committee to remove the donor race and hepatitis C virus (HCV) status variables. The updated KDRI model was fit on adult, deceased donor, solitary kidney, first-time transplants from 2018-2021. Deceased donors from 2018 through 2021 were included in a counterfactual analysis to evaluate how the kidney donor profile index (KDPI) would change if race and HCV seropositivity were excluded. When recalculating the original KDRI models on 2018-2021 transplants, the donor Black race coefficient was only slightly lower (β = 0.18 in the original model; β = 0.15 in the 2018-2021 cohort), while the donor HCV seropositivity coefficient was substantially lower (β = 0.24 in the original model; β = -0.04 in the 2018-2021 cohort). Among Black donors, the probability of being classified as KDPI ≤20% increased and the probability of being classified as KDPI >85% decreased notably when the Black race and HCV variables were removed from the model. Removing the donor race and donor HCV status variables in an updated KDRI model resulted in more racially equitable KDPI distributions.
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