Abstract: FR-PO0964
Using Kidney Paired Donation to Achieve the Goals of the Increasing Organ Transplant Access (IOTA) Model
Session Information
- Transplantation: Clinical - Pretransplantation, Living Donation, and Policies
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Thomas, Alvin G., New York University Grossman School of Medicine, New York, New York, United States
- Fleming, James, National Kidney Registry, Greenwich, Connecticut, United States
- Massie, Allan, New York University Grossman School of Medicine, New York, New York, United States
- Cooper, Matthew, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Segev, Dorry L., New York University Grossman School of Medicine, New York, New York, United States
Background
A mandatory 6-year payment model involving 103 non-pediatric kidney transplant centers will begin 7/2025. Centers meeting policy-defined achievement, efficiency, and quality metrics can earn up to $15,000 per fee-for-service kidney transplant (KT). Joining a kidney paired donation (KPD) network may help centers increase living donor KT (LDKT) rates and achieve IOTA goals.
Methods
61 (54%) centers joined NKR as an all-in center during the study period representing 26,276 (60%) LDKTs. After adjustment, centers that joined NKR increased their monthly LDKT rate by 1.00 LDKTs (95% CI: 0.51, 1.49; p<0.001); centers that did not join may have experienced a decrease in LDKT rates (-0.44; 95% CI: -0.81, -0.08; p=0.2). If the IOTA model were retrospectively applied for the study period for the 35 NKR all-in centers currently to IOTA, 15/35 (43%) of centers would have met IOTA goals based on increased LDKT rates alone.
Results
There were 61 (54%) centers that joined NKR as an all-in center during the study period representing 26,2765 (60%) of LDKTs. Prior to the event date (joining NKR or median date), the monthly LDKT rates were 3.1 and 2.8 LDKTs for future NKR all-in centers and non-NKR centers, respectively. After the event date, the mean monthly LDKT rates were 3.6 and 2.6 LDKTs for NKR and non-NKR centers, respectively. After adjustment, joining NKR was associated with 0.99 (p<0.001) more LDKTs per month. If the IOTA model were retrospectively applied for the study period for the 35 NKR all-in centers currently randomized to IOTA, 15/35 (43%) of centers would have met IOTA goals based on increased LDKT rates alone.
Conclusion
KPD participation may help centers increase their LDKT rates, allowing them to help more patients, increase revenue, and meet IOTA targets. Additional strategies will be necessary to increase access to KT and maximize receipt of IOTA model incentives.
Funding
- NIDDK Support