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. 2025 Jun 19;10(9):3094-3101.
doi: 10.1016/j.ekir.2025.06.025. eCollection 2025 Sep.

Acceptance of High Kidney Donor Profile Index Kidneys Among Consented Candidates

Miko Yu  1   2 , Lindsey M Maclay  1   2 , Riya Lahiri  1   2 , Syed Ali Husain  1   2 , Jesse D Schold  3   4 , Sumit Mohan  1   2   5
Affiliations

Acceptance of High Kidney Donor Profile Index Kidneys Among Consented Candidates

Miko Yu et al. Kidney Int Rep. .

Abstract

Introduction: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

Keywords: high KDPI; kidney allocation; kidney transplant.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Temporal trends in transplants of the highest KDPI kidneys. KDPI, Kidney Donor Profile Index.
Figure 2
Figure 2
Temporal trends in the proportion of kidneys placed with top-ranked candidates. The black vertical lines indicate KAS policy changes in 2014 and KAS250 in 2021, respectively. KAS, Kidney Allocation System; KDPI, Kidney Donor Profile Index.
Figure 3
Figure 3
Temporal trends in the median number of declined offers for kidneys before transplant. The black vertical lines indicate KAS policy changes in 2014 and KAS250 in 2021, respectively. Offers which correspond to voluntary center-selected bypass filter criteria are included in the count of declined offers. KAS, Kidney Allocation System; KDPI, Kidney Donor Profile Index.
Figure 4
Figure 4
The relationship between center-level proportion of candidates consented to high KDPI kidneys among the prevalent waitlist population and the SRTR-reported center-level offer acceptance ratio for high KDRI kidneys. (a) The red line references an offer acceptance ratio of 1. (b) The proportion of the prevalent population that consented to high KDPI kidneys has been relatively stable, except lower rates in 2014 to 2015, which were likely a function of the recent introduction and implementation of the KAS in late 2014. KAS, Kidney Allocation System; KDPI, Kidney Donor Profile Index; SRTR, Scientific Registry of Transplant Recipients.
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References

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