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.

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.