Impact of the 2024 OPTN KDPI Rescoring on Donor Kidney Utilization and Allocation Out-of-Sequence: A Six-Month Analysis

Shengliang He; Christie Thomas; Alan Reed

doi:10.1016/j.ajt.2025.12.189

Background: On October 31, 2024, the Organ Procurement and Transplantation Network (OPTN) removed hepatitis C virus nucleic acid test (HCV NAT) positivity and African American/Black (AA/B) donor race from the Kidney Donor Profile Index (KDPI) calculation. This study evaluates the early impact of this policy change on kidney utilization during its first six months. Methods: We performed a retrospective analysis of OPTN data for all adult deceased donor kidney transplants between May 1, 2024, and April 30, 2025. Donors were stratified by HCV NAT status and race. Kidney utilization rates and percentage of allocation out-of-sequence (AOOS) were compared between the pre-policy period (May-October 2024) and post-policy period (November 2024-April 2025). Statistical comparisons used two-proportion z-tests, with significance set at p < 0.05. Results: For HCV NAT-positive kidneys, overall utilization decreased from 71.6% pre-policy to 69.3% post-policy (p = 0.34), with declines in all allocation sequences except sequence B; sequence C demonstrated a significant drop (p < 0.001) (Table 1). AA/B donor kidneys showed a 3.3% absolute increase in overall utilization (67.4% to 70.7%, p = 0.02), but utilization rate decreased in all allocation sequences, with a significant decline in sequence C (p = 0.003). The utilization rate of HCV NAT-negative and non-Black donor kidneys increased in all allocation sequences, with significant gains in sequences B, C, and D; however, overall utilization rates for these groups remained stable. When considering all donor kidneys during the study period, overall utilization increased slightly, from 70.2% pre-policy (10,513/14,970) to 70.6% post-policy (10,407/14,735; p = 0.45). The percentage of AOOS decreased across all allocation sequences except the high KDPI group, with an overall decline from 22.6% pre-policy to 21.6% post-policy (p = 0.07) (Table 2). Conclusion: The policy changes increased utilization of kidneys from AA/B donors but not from HCV NAT-positive donors. Utilization rates declined in most allocation sequences post-policy despite KDPI recalculation prioritizing both groups. Improved KDPI calculation may have contributed to the observed reduction in out-of-sequence allocation, although this finding could also reflect short-term fluctuation given the limited study period.

Impact of the 2024 OPTN KDPI Rescoring on Donor Kidney Utilization and Allocation Out-of-Sequence: A Six-Month Analysis

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