Race removed from kidney transplant evaluation criteria

The Organ Procurement and Transplantation Network (OPTN) has announced plans to revise the Kidney Donor Profile Index (KDPI) calculation by removing the African American/Black race coefficient. Leading kidney health organizations have welcomed this change as a step towards improving equity in organ transplantation.

The National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) issued a joint statement supporting the revision. Dr. Deidra C. Crews, president of the ASN, noted that the updated formula would more accurately reflect the likelihood of graft failure for kidneys from deceased donors, acknowledging that race is a social construct rather than a biological one.

Dr. Sylvia E. Rosas, president of NKF, emphasized the organization’s commitment to advancing health equity in kidney care. She expressed optimism that removing the race coefficient from the kidney evaluation score will likely improve transplant equity and increase the number of kidney transplants available.

Kevin Longino, CEO of the NKF and a kidney donation recipient, described the previous inclusion of the race coefficient as detrimental to African American/Black donors and patients awaiting kidney transplants. He commended OPTN for implementing this change.

In addition to removing the race factor, the updated KDPI will no longer consider whether the donor was Hepatitis C Virus positive. This change reflects recent therapeutic advances that have led to similar post-transplant outcomes for HCV-positive and negative donor kidneys.

Dr. Cynthia Delgado, who participated in the OPTN task force that led efforts to reconsider the use of race and HCV in the formula, explained that the new approach may result in some kidneys receiving more favorable scores. This could potentially classify some organs as more suitable for transplantation that might have previously been considered unsuitable due to the inclusion of race in the formula.

The proposed change was included in OPTN’s 2024 winter public comment period and was approved by the OPTN board in June 2024. The NKF and ASN have advocated for this change through ongoing correspondence with OPTN. Last September, NKF launched a nationwide petition calling for removing the African American/Black race coefficient from the KDRI as part of its KIDNEY EQUITY FOR ALL initiative.

Currently, nearly 90,000 individuals are on the national kidney transplant waitlist. The revised KDPI calculation represents a significant step towards addressing disparities in kidney transplantation and improving access to life-saving organ donations for all patients.