Allocation of Kidney Allografts From Donors With Kidney Donor Profile Index <35% and the Impact of Kidney Donor Profile Index Revisions on Access to Transplantation for Children

RATIONALE & OBJECTIVE: Children in the United States receive priority for kidneys with a kidney donor profile index (KDPI) < 35%, although their priority falls below that of certain adult recipients. Recently, the KDPI was revised to include 8 donor characteristics instead of 10. We sought to (1) describe the allocation of these high-quality kidneys and (2) compare the characteristics of donors with a KDPI < 35% using the original KDPI (KDPI-10) versus the revised KDPI (KDPI-8) calculation. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: 60,587 deceased donors and their kidney recipients in the Organ Procurement and Transplantation Network registry between January 1, 2018, and December 31, 2023. EXPOSURE: KDPI calculated using KDPI-10 and KDPI-8 (without race and hepatitis C virus [HCV]). OUTCOME: The primary outcome was the use of kidneys with a KDPI < 35% overall. Secondary outcome was the utilization of kidneys from "ideal pediatric-quality donors" who were defined as having a KDPI < 35%, diagnosed with brain death, were aged