Risk, Prognosis, and Unintended Consequences in Kidney Allocation

Proposed changes to the allocation system for deceased-donor kidneys rely on unvalidated models that may unfairly reduce transplantation opportunities for some patients, inappropriately benefit others, and have unintended consequences for donation by living donors. The gap between the supply and demand of transplantable kidneys is growing, leaving policymakers eager to maximize the benefit of every kidney transplanted. Recently, a proposal for changing the way kidneys from deceased donors are allocated was proffered for public comment by the Kidney Committee of the Organ Procurement and Transplantation Network (OPTN). 1 Instead of continuing to use a patient's waiting time as the core determinant of allocation priority, the new system employs a “risk quantification score” called the Kidney Donor Profile Index (KDPI) combined with a calculated Estimated Post-Transplant Survival (EPTS) score in an attempt to quantify risk factors . . .