Alternative kidney transplant options

Kidney donor profile index (KDPI) is a way to group kidneys. All donors are given a number from 1 to 100 based on different factors. The number shows how long a deceased donor kidney might function compared to other kidneys. The lower the number, the longer the kidney might function.

The kidney will be given a half-life, or average number of years that half the transplanted kidney with that KDPI score are still working in most patients.

KDPI scores explained

• Low KDPI (less than 20): Often offered to children and young, healthy adults with longer estimated life spans. Half-life of 11.5 years.
• KDPI 20-85: Make up most deceased donor kidneys. Half-life of 9 years.
• High KDPI (greater than 85): Often from donors older than 60, or 50 years old with high blood pressure, diabetes, slightly reduced kidney function, or who died from a stroke. Half-life of 7 years.

Deciding on the type of organ to accept is complex. Your choice is influenced by your own risk profile, the transplant center’s wait time, and your personal choices.

Risk criteria kidney donors are donors who have a potential risk for three infections: human immunodeficiency virus (HIV), hepatitis B (HBV), or hepatitis C (HCV). Almost all recipients should consider this option.

All kidney donors, deceased and living, are tested for common transmissible viruses, like HIV, HBV, and HCV. Most kidney donors are negative, but there are some donors that are thought to have a higher risk of transmitting these viruses and still test negative for them. The overall risk of a virus being passed from one of these donors is very low.

Risk criteria donor behaviors

The public health service defines risk criteria kidney donors as donors with at least one of the following behaviors within three months before donation.

• Injecting drugs for nonmedical reasons
• Incarceration for more than 72 hours
• A man who has had sex with another man
• Sex in exchange for money
• Sex with a person known to have HIV, HBV, or HCV
• Donors with unknown medical histories

Factors to consider

• It is very rare to get infected with HBV or HCV, and both can be cured or controlled by taking medicine. Regardless of the donor, all recipients are tested for viral infections during the first year after transplant.
• Most of these organs come from donors that tend to be younger and healthier than the average donor you might be offered organs from.
• If you don’t accept a risk criteria organ, the other option is to stay on the wait list until a different organ is available. This comes with its own risks, and you don’t know when the next organ will be available.

Another option is accepting a kidney from a donor previously infected with hepatitis B (HBV) or hepatitis C (HCV). Some of these donors have gotten rid of the virus and some are still actively infected. These can still be excellent donors.

• Advantage: Get transplanted quicker.
• Disadvantages: You will likely need to take oral medicines to prevent or treat an infection. These medicines are very effective, and the risk of transmission can be very low. An infection can still occur and if not successfully treated, can cause hepatitis or inflammation of the liver, which can lead to cirrhosis (severe scarring of the liver).