Election to be Listed to Receive Organ Offers from a Donor
with a Kidney Donor Profile Index (KDPI) > 85%
An expanded criteria donor (ECD) is a donor with health problems known to be associated with kidney damage. A donor is considered an ECD if they exhibit the following criteria, as determined by the United Network for Organ Sharing (UNOS):
- Age greater than 60 years, or
- Age 50-59 years with at least two of the following:
- High Blood Pressure
- Decreased kidney function with a serum creatinine level greater than 1.5 mg/dl
- Death as a result of a stroke or aneurysm
Previously, patients who wanted to be considered for an ECD kidney and a Standard Criteria Donors (SCD) kidney to increase their opportunity to receive a kidney offer signed a special consent to be included on the ECD waiting list. The benefit to this decision was an increased chance of less time on the waiting list as it is known that longer waiting times are associated with poorer post-transplant outcomes.
Beginning in late 2014, all transplant programs will use a new means of measuring the quality of donor kidneys called the Kidney Donor Profile Index (KDPI). KDPI grades the usability of deceased donor kidneys with a score between 1 and 100. A kidney with the highest potential to function has a score of 1 and a kidney with the lowest potential to function has a score of 100. Under the new KPDI system, kidney donors with a KDPI of greater than or equal to 85 are considered ECD donors. Patients will need to consent to be on the waitlist for KDPI >85 kidneys.
Additional risks that may be associated with these KDPI >85 kidneys as compared to a SCD kidney include:
- Delay in kidney function post-transplant. This delay could last for several days or several weeks and may require the recipient to need dialysis. This is called delayed graft function. This could happen with a SCD kidney or a lower KDPI kidney also.
- Recipients with delayed graft function may have a longer hospital stay.
- About 1-2% of KDPI >85 kidneys may never work well enough for the recipient to be completely off dialysis. This is a slightly higher risk than with a SCD kidney.
- A KDPI> 85 kidney may not function as long as a SCD kidney. Nationally, 89% of SCD kidneys are functioning at one year, while 82% of KDPI> 85 kidneys are functioning. At three years these numbers are 75% for SCD kidneys and 66% for KDPI > 85 kidneys.