Insights into the labelling effect of KDPI reporting: the Australian experience

Abstract

In 2016 Australia began reporting the Kidney Donor Performance Index (KDPI) with all deceased donor kidney transplant offers despite this not being used in organ allocation rules, offering a unique opportunity to explore the 'labelling effect' of KDPI reporting. We reviewed all kidneys retrieved for transplantation in Australia from 2015-2018 and analysed the association of KDPI reporting with organ non-utilisation, number of offer declines and donor/recipient age and longevity matching. Analyses were stratified by organ failure risk: higher risk (KDPI>80%), standard risk (KDPI 20-79%) and lower risk (KDPI 0-20%). There was no significant difference in organ non-utilisation post KDPI reporting either overall or for higher risk kidneys. KDPI reporting was associated with an increase in offer declines for both higher risk (IRR 1.45, p=0.007) and standard risk (IRR 1.22, p=0.021) kidneys, but not for lower risk organs. There was a significant increase in recipient age and Expected Post-Transplant Survival score for higher risk kidneys but no differences amongst other groups. We conclude that whilst KDPI reporting in Australia has been associated with an increased number of offer declines for higher risk kidneys, this has not resulted in increased non-utilisation and may have contributed to more appropriate use of these organs.