Acceptance of High Kidney Donor Profile Index Kidneys Among Consented Candidates

The Kidney Donor Profile Index (KDPI) is a percentile score based on the relative risk of allograft failure for deceased donor kidneys, where higher scores indicate shorter estimated allograft longevity. The Organ Procurement and Transplantation Network policy requires patients to proactively opt-in via written consent to receive offers for "high-KDPI" (> 85%) kidneys before being considered for organs in this category.

This retrospective cohort study examined United States (US) candidates and recipients from 2012 to 2022 to determine if consent for less-than-ideal organs impacted organ allocation, efficiency, and utilization.

Among 138,242 deceased donor transplants, 7031 (5%) were from KDPI of 80% to 85% kidneys, 4847 (4%) from KDPI of 86% to 90% kidneys, and 6089 (4%) from KDPI > 90%. Among transplants with KDPI of 86% to 90% kidneys, representing the best quality among high-KDPI organs, 10% of recipients in 2014 were top-ranked candidates compared with 5% in 2015 and 4% in 2022. The number of declined offers for KDPI of 86% to 90% kidneys increased following implementation of the Kidney Allocation System (11 [interquartile range, IQR: 2-52] in 2014 versus 21.5 [IQR: 6-109] in 2015 vs. 52 [IQR: 12-323] in 2022).

These findings demonstrate changes in the centers' willingness to accept high KDPI kidneys on behalf of their patients after the introduction of the KDPI label and other changes in allocation policy and regulatory oversight in the system.