The Kidney Transplant Waitlist and High KDPI Kidneys

When a deceased donor kidney becomes available, it is scored by the Kidney Donor Profile Index (KDPI). The lower the score, the longer the kidney is predicted to work. 

How is the KDPI used? When would someone consider a high-KDPI kidney? 

Dr. Anne Hummel, a transplant nephrologist, and Nicole Jefferson, a two-time high KDPI kidney transplant recipient, are here to give you the facts. 

The Kidney Transplant Waitlist

Over 80,000 people are waiting for a kidney transplant in the United States.¹ While more than 27,000 kidney transplants were performed in 2023, thousands still wait for a second chance at life.² Of those, twelve will die each day.³ 

"Many more patients are waiting for transplants than organs available," Dr. Hummel said. That’s why people often wait 3-5 years on average for a transplant. In some areas of the country, the wait might be even longer." 

The journey to the kidney transplant waitlist begins with a transplant center referral. From there, potential recipients undergo physical and physiological testing to ensure they are fit for transplantation. 

Other factors, called social determinants of health, also impact someone’s access to the waitlist. These are the conditions where people are born, live, learn, work, play, and worship. They can affect your health and quality of life.

For those who are deemed fit for transplantation, there are two types to consider–living and deceased. 

• Living donation: A potential donor goes through a living kidney donor evaluation to ensure they are a good fit. A living donor kidney usually starts working more quickly and has less chance of rejection. 
• Deceased donation: A deceased donor kidney becomes available and is evaluated with the KDPI. The KDPI assesses how well the kidney should function. A high KDPI isn’t expected to last as long as a low one.

Want to learn more about the transplant waitlist or living donation? The Kidney Learning Center has the information you need. Find a free course that best fits where you are in your kidney disease journey. 

Understanding deceased kidney donation 

When a family agrees to donate their loved one's organs, the closest organ procurement organization collects information about the donor. They are also in charge of transporting the organ to the recipient. 

"They use the KDPI to predict how long the kidney may last using information gathered about the donor. Age, height, weight, medical conditions, race, ethnicity, and cause of death are taken into consideration," said Dr. Hummel. "The score and donor characteristics are then shared with transplant centers through a national electronic database."

Each transplant center has its own criteria for accepting the kidney. Some may be more willing to accept a higher KDPI score.

A KDPI Score:

• Between 0 and 19 may last 10 to 15 years. 
• Between 20 and 84 may last 10 to 15 years.
• Greater than 85 may last between 7 to 10 years.

Learn more about the Kidney Donor Profile Index (KDPI).

Underutilized kidneys

The Organ Procurement and Transplantation Network (OPTN) discards about 1 in 5 deceased donor kidneys each year.⁴ Why so many?

A donated kidney can only last so long out of the body. Because each center sets the criteria for a deceased kidney, the OPTN has to first find a center willing to accept it. Then they have to get the organ to them. Often the kidney doesn't make it to anyone in time.

Using race in the KDPI also adds to the high number of kidneys being needlessly discarded. Race is a social construct that has no bearing on how well someone's kidneys work.

Join the fight. Together, we can build a future with KIDNEY EQUITY FOR ALL™ and ensure ALL patients have access to high-quality care, regardless of race, ethnicity, gender, or sexual orientation.  

Considerations for Accepting High KDPI Kidneys

When should someone consider accepting a high KDPI kidney?

"About four out of ten people on the waiting list consent to receive offers of high KDPI kidneys," said Dr. Hummel. "The threshold for accepting high KDP kidneys varies depending on personal factors. In my opinion, potential recipients who need to expand their opportunities for kidney transplant should consider accepting high KDPI kidneys."

These personal factors include:

• A long waitlist time.
• Health declines that may disqualify future transplantation.
• Difficulty tolerating dialysis.

For Nicole, whose kidneys failed in 2003, a high KDPI kidney was preferable to spending more time on dialysis. 

"I was looking for a living kidney when I got the call that a high KDPI kidney was available. The kidney came from a donor with high blood pressure and diabetes. They predicted it would last 4 to 6 years. That would give me more time to find a living donor if I needed one," said Nichole. "That kidney lasted 12 years."

Once that kidney showed signs of failing, Nicole opted for a preemptive transplant using a high KDPI kidney. With this, Nicole didn’t have to go back on dialysis. 

"The right kidney can come from an unexpected place. My donor passed away after spending three days in jail on drug-related terms. I knew my team wouldn’t offer me a kidney they thought would do more harm than good. I accepted it," Nicole said. "It's been an amazing seven years. I have not felt this good since before my kidney failure started." 

Ask these questions to learn if a high KDPI kidney is right for you.

Sources

¹“National Data - OPTN.” Organ Procurement and Transplantation Network, 1 Mar. 2024, optn.transplant.hrsa.gov/data/view-data-reports/national-data/#. 
²2023: Organ Donors Save Record Number of Lives, UNOS, Jan. 2024, unos.org/about/success-of-national-organ-donation-and-transplant-system/. 
³“National Data - OPTN. 2022 Report,” Organ Procurement and Transplantation Network
⁴Lentine KL, Smith JM, Lyden GR, Miller JM, Dolan TG, Bradbrook K, Larkin L, Temple K, Handarova DK, Weiss S, Israni AK, Snyder JJ. OPTN/SRTR 2022 Annual Data Report: Kidney. Am J Transplant. 2024 Feb;24(2S1):S19-S118. doi: 10.1016/j.ajt.2024.01.012. PMID: 38431360