1. Introduction to Kidney Donor Risk Index (DRI)
Data Update
Introduction to Kidney
Donor Risk Index (DRI)

2. Donor Risk Index (DRI)
ECD/SCD definition of donor quality is insufficient as many so called “ECD” kidneys are of equal or better quality than some “SCD” kidneys
The SRTR has developed continuous measures that better quantify the risk associated with certain organs and has published these for liver and kidney1,2.
The OPTN/UNOS Kidney Transplantation Committee has been considering ways to introduce the concept of a Donor Risk Index into a new allocation system
1Feng et al., Characteristics associated with liver graft failure: the concept of a donor risk index. Am J Transplant. 2006;6:
2Rao et al., A comprehensive risk quantification score for deceased donor kidneys: the kidney donor risk index. Transplantation 2009;88:

3. Objectives of this Presentation
To illustrate some basic donor recovery information stratified by the DRI rather than just the ECD/SCD/DCD criteria.
To familiarize you with the concept of the DRI and help you to understand how various donor characteristics relate to DRI.
To examine some of the variability in donors recovered by DRI across regions and DSAs.

4. This slide illustrates the overlap in the SCD and ECD donor population in terms of relative risk of failure. The grey bars show the % of transplants done that were classified as SCD, and the white bars illustrate the ECD transplants. This slide shows that there is not a single “cut-point” where an SCD donor ends and an ECD donor begins.

5. Factors included in Kidney DRI Calculation1
Donor
Age
Ethnicity
Serum Creatinine
Hypertension
Diabetes
Cause of death
Height
Weight
DCD
HCV+
Transplant *
HLA Mismatch Level
Cold ischemia time
Transplant type (enbloc/double/single)
1Rao et al., A comprehensive risk quantification score for deceased donor kidneys: the kidney donor risk index. Transplantation 2009;88:
* Transplant factors were set to “baseline” for this presentation

6. Deceased Donors by Type 1998 – 2008 U.S.
For years, we’ve shown you slides like this – donors recovered in 3 categories.

7. Kidney Donor Risk Index Deceased Donors Recovered
This slide illustrates the same information, using 5 categories of donor risk.

8. Kidney Donor Risk Index Deceased Donors Recovered
When you look at the percentage of donors recovered in each of the categories, you can see that the biggest increases are seen in the white and green sections of the bars – illustrating the highest risk categories

9. All Deceased Donors Recovered 2008 Kidney DRI Distribution

10. The following slides show the distribution of the Kidney Donor Risk Index for various donor characteristics

11. How to interpret the boxplots…
95th Percentile
75th Percentile
Median
(middle of box)
You may or may not want to include this slide. Shows you how to describe the following slides.
25th Percentile
5th Percentile

12. All Deceased Donors Recovered 2008
Kidney DRI By Donor Age

13. All Deceased Donors Recovered 2008
Kidney DRI By Donor Age

14. All Deceased Donors Recovered 2008 Kidney DRI By Donor Ethnicity

15. All Deceased Donors Recovered 2008 Kidney DRI By Donor Cause of Death

16. All Deceased Donors Recovered 2008 Kidney DRI By Donor Gender

17. All Deceased Donors Recovered 2008
Kidney DRI By Donor BMI

18. All Deceased Donors Recovered 2008
Kidney DRI By Donor BMI

19. All Deceased Donors Recovered 2008 –
Kidney DRI By Donor Type (SCD/DCD/ECD/ECD&DCD)

20. All Deceased Donors Recovered
Kidney DRI 1998 vs. 2008

21. All Deceased Donors Recovered
Kidney DRI 1998 vs. 2008

22. All Deceased Donors Recovered 2008
Kidney DRI by Region

23. All Deceased Donors Recovered 2008
Kidney DRI Quintile by Region of Recovery

24. Donors Recovered vs. Median DRI
Lower Volume
Higher Risk
Higher Volume
Higher Risk
This slide is just for illustration purposes – use it to explain the next slide. Wide variability in the volume of donors recovered – and variability in DRI across DSAs.
Lower Volume
Lower Risk
Higher Volume
Lower Risk

25. All Deceased Donors Recovered 2008
Donors Recovered vs. Median Kidney DRI
Each dot represents a DSA. The axes cross at the median DRI for donors (1.27) and at the median # of donors recovered across DSAs (~125) in This raises a number of questions – should there be uniformity across DSAs? Are those with a median DRI much higher than US median pushing the envelope too far? Or, are those with DRI< national median not pushing hard enough? We don’t know the answer to that question, but it is interesting to consider.

26. All Deceased Donors Recovered 2008
Region 1

27. All Deceased Donors Recovered 2008
Region 2

28. All Deceased Donors Recovered 2008
Region 3

29. All Deceased Donors Recovered 2008
Region 4

30. All Deceased Donors Recovered 2008
Region 5

31. All Deceased Donors Recovered 2008
Region 6

32. All Deceased Donors Recovered 2008
Region 7

33. All Deceased Donors Recovered 2008
Region 8

34. All Deceased Donors Recovered 2008
Region 9

35. All Deceased Donors Recovered 2008
Region 10

36. All Deceased Donors Recovered 2008
Region 11