Improving Dual Kidney Allocation Finally, we will briefly review the Kidney Committee’s concept paper on Improving Double Kidney Allocation. I want to be sure to emphasize that that this document is not a policy proposal, it is a concept paper. The intent of the concept paper is to inform all interested parties about the status of the Committee’s discussions and seek valuable input for further consideration. We plan to circulate a policy proposal during the public comment cycle in the fall of 2017. The Dual Kidney paper is available in your handouts for today’s meeting, so I encourage you to follow along.

What problem will the proposal solve? Discard rates for high KDPI kidneys is at or above 50% Policy 8.6: Dual Kidney Allocation needs to be updated to promote efficient placement As many of you know, discard rates for high KDPI kidneys is at or above 50%. However, the graft survival advantage of dual kidney transplantation, in which both kidneys from an older or otherwise non-ideal donor are transplanted into the same patient have been widely published. Members have also indicated current dual kidney allocation policy is ambiguous, needs to be updated, and does not enable timely identification and allocation of kidneys suitable for dual transplantation. Specifically, current policy 8.6: Dual Kidney Allocation, implemented over 2 decades ago, does not provide sufficient direction for OPOs on how and when to allocate kidneys dually. By revising the policy, the Kidney Committee sees this project as one step to addressing the problem of the increased numbers of discarded high KDPI kidneys post-KAS

Improving Dual Kidney Allocation Project Update Improving Dual Kidney Allocation The Committee has published a concept paper identifying three possible solutions to address the problem The Committee requests feedback on the community’s preferred option Concept Paper available for public comment through March 24, 2017 Public comment proposal: Fall 2017 public comment cycle The Dual Kidney Allocation Subcommittee had a number of solutions to address the optimal identification and allocation of the most challenged donor kidneys, those that would have a high probability of discard if offered as a single kidney. Each of the three concepts addresses opportunities to place these kidneys as duals either prior to organ retrieval or following the receipt of further post retrieval information. The values in these concepts for age, KDPI, time post cross clamp, etc. are not fixed but are also out for your comments as well. The Kidney Committee seeks feedback on these three possible solutions, or blended parts of these concepts, for an upcoming policy proposal for Dual Kidney Allocation. This concept paper is intended to inform all interested stakeholders about the status of the Committee’s discussions and seek input for further consideration. We are asking the community to review the paper and submit feedback on the OPTN Web site. The preferred concept will then be refined and circulated this fall as a public comment proposal.

Questions? Mark Aeder Kidney Committee Chair mark.aeder@uhhospitals.org Chelsea Rock Haynes Kidney Committee Liaison chelsea.haynes@unos.org I’m happy to take any final questions you have on the Dual Kidney concept paper before concluding the Kidney Committee’s update. You’re also welcome to reach out to our Committee Chair or our Liaison from UNOS. Thank you.