Kidney Week 2025 Annual Meeting-Kidney Transplant Modernization: Policies, Allocation, and Strategies

Video Transcription

Video Summary

The session “Kidney Transplant Modernization, Policies, Allocation, and Strategies” reviewed rapid changes in U.S. kidney transplantation and the policy tensions they create. Dr. Jesse Schold summarized 2020–2025 trends: kidneys recovered rose ~39% and deceased-donor transplants ~30%, with donation after circulatory death now about half of deceased donors. Allocation changes (KAS-250 geographic sharing) increased transport distance, machine perfusion use grew sharply, and placing organs has become harder—acceptance occurs later in match runs and non-utilization (“discard”) has increased. He highlighted rising offer volume nationally, shifting definitions of “high KDPI” risk, and growing scrutiny of “allocation out of sequence” (OOS). He also reviewed evolving transplant-center metrics (fewer flagged for poor outcomes; more focus on offer-acceptance), the CMS IOTA randomized payment model incentivizing growth and efficiency, and HRSA’s directive to collect national pre-waitlist referral/evaluation and potential donor data.<br /><br />Dr. Rich Formica argued non-use and OOS are linked system problems. He described how KAS-250 and CMS OPO metrics coincided with increased OOS, especially as higher-KDPI and more complex (often DCD) kidneys entered the pool. He proposed a transparent, NODA-compliant “rescue allocation” algorithm using sequence-number triggers and batch offers, tuned to non-use rates, which simulations suggest could cut non-utilization substantially.<br /><br />OPO leader Prof. Alexandra Glazier framed OPOs as public-health infrastructure connecting community, hospitals, and transplant centers. She showed inefficiencies (thousands of offers per unused kidney) and presented an OPO pilot where stopping expedited rescue increased high-KDPI non-use, supporting standardized rescue protocols. She warned negative media has reduced registrations and donors, and criticized misaligned CMS OPO regulations that may drive destabilizing consolidation.<br /><br />Patient-recipient Dr. Ernest Davis argued OPTN modernization has been insufficiently “patient-forward,” calling for stronger patient input mechanisms, more transparent patient-relevant data, improved communications, and policies that reflect patient priorities.

Asset Subtitle

Moderator(s): Rachel Engen, Martha Pavlakis

Presentation(s):

Current State of Kidney Allocation: Update on Organ Procurement and Transplantation Network Modernization - Jesse Schold
Kidney Allocation: Strategies to Improve Placement and Utility - Richard Formica
Organ Procurement Organizations of Tomorrow: Regulations, Best Practices, and Innovation - Alexandra Glazier
Organ Procurement and Transplantation Network Modernization: The Patient Perspective - Earnest Davis

Meta Tag

Date 11/7/2025

Pathway 1 Kidney Transplantation

Session ID 507644

Keywords

kidney transplant modernization

U.S. kidney transplantation policy

OPTN modernization

KAS-250 geographic sharing

kidney allocation system

donation after circulatory death (DCD)

deceased-donor kidney transplant

kidney non-utilization (discard)

organ offer acceptance

match run sequence

allocation out of sequence (OOS)

machine perfusion

high KDPI kidneys

CMS IOTA payment model

OPO metrics and regulation