Simultaneous Pancreas and Kidney Transplant and Multi-Organ Kidney Transplant Allocation

Allocation of deceased donor renal allografts for transplant is complicated by the competing interests of multiorgan transplants (MOT) that include a kidney as a secondary organ (with a liver, lung or heart as the primary organ), simultaneous pancreas and kidney (SPK) transplants (that remove a patient from the kidney waiting list), and high priority kidney alone candidates such as prior living donors, pediatric recipients, and highly sensitized individuals. Furthermore, there are more than 80,000 candidates waiting for a kidney transplant alone without such priority. In the case of SPK transplant, the kidney is the primary organ transplanted and the pancreas is the accompanying organ, requiring candidates to be subject to the same listing criteria as kidney alone candidates. In comparison, candidates for other MOTs that include the kidney are not placed on the kidney waiting list and subject mainly to the listing criteria of the primary organ. This report will present how SPK transplant should be considered in the context of kidney allocation and outline the rationale as to why an SPK transplant should not be batched with other MOTs in allocation decisions. SPK transplants should rightfully continue to be regarded as a kidney transplant of the upmost priority secondary to the higher mortality of these candidates on the kidney waitlist, the demonstrated survival advantage of the combined transplant, and the unavoidable increased non-utilization of suitable pancreas allografts if it does not accompany a kidney.