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Impact of the 2024 Organ Procurement and Transplantation Network Kidney Donor Profile Index Rescoring on Donor Kidney Utilization and Allocation out of Sequence: A one‐Year Analysis
Journal article   Open access   Peer reviewed

Impact of the 2024 Organ Procurement and Transplantation Network Kidney Donor Profile Index Rescoring on Donor Kidney Utilization and Allocation out of Sequence: A one‐Year Analysis

Shengliang He, Christie P. Thomas and Alan I. Reed
Clinical transplantation, Vol.40(6), e70604
06/23/2026
DOI: 10.1111/ctr.70604
PMID: 42338014
url
https://doi.org/10.1111/ctr.70604View
Published (Version of record) Open Access

Abstract

Background In October 2024, the Organ Procurement and Transplantation Network (OPTN) removed hepatitis C virus (HCV) 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 year. Methods We performed a retrospective analysis of OPTN data for organ procurements and adult deceased-donor kidney transplants between November 2023 and October 2025. Donors were stratified by HCV status and race. Kidney utilization and allocation out-of-sequence (AOOS) were compared between pre-policy (November 2023–October 2024) and post-policy (November 2024–October 2025) periods. Results The policy revision was associated with redistribution of HCV+ and AA/B donor kidneys toward lower KDPI category, with increases of 989% and 144%, respectively, in the 0–20% KDPI range. Overall utilization increased among AA/B (66.9% to 71.5%), non-AA/B (70.1% to 72.1%), HCV− (69.6% to 72.0%), and HCV+ donors (70.3% to 72.5%). However, utilization within individual KDPI categories declined for AA/B and HCV+ donors across most strata, except for the 21–34% category among HCV+ donors. AOOS decreased from 20.2% to 16.8% (absolute reduction 3.4%; 95% confidence interval, −4.1% to −2.6%). Conclusion The policy was associated with increased overall utilization across donor groups. However, gains among AA/B and HCV+ donors appear primarily driven by redistribution into different allocation sequences rather than improvement in within-category utilization. Reduced AOOS suggests improved allocation efficiency, though findings may be influenced by concurrent regulatory changes.
 allocation out-of-sequence (AOOS) donor race Hepatitis C virus (HCV) Kidney Donor Profile Index (KDPI) kidney utilization UIOWA OA Agreement

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