Impacts of removing race from the calculation of the kidney donor profile index

Jonathan Miller, Grace R. Lyden, Warren T. McKinney, Jon J. Snyder, Ajay K. Israni

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


The kidney donor risk index (KDRI), standardized as the kidney donor profile index (KDPI), estimates graft failure risk for organ allocation and includes a coefficient for the Black donor race that could create disparities. This study used the Scientific Registry of Transplant Recipients data to recalculate KDRI coefficients with and without the Black race variable for deceased donor kidney transplants from 1995 to 2005 (n = 69 244). The recalculated coefficients were applied to deceased kidney donors from 2015 to 2021 (n = 72 926) to calculate KDPI. Removing the Black race variable had a negligible impact on the model's predictive ability. When the Black race variable was removed, the proportion of Black donors above KDPI 85%, a category with a higher risk of organ nonuse, declined from 31.09% to 17.75%, closer to the 15.68% above KDPI 85% among non-Black donors. KDPI represents percentiles relative to all other donors, so the number of Black donors moving below KDPI 86% was roughly equal to the number of non-Black donors moving above KDPI 85%. Removing the Black donor indicator from KDRI/KDPI may improve equity without substantial overall impact on the transplantation system, though further improvement may require the use of absolute measures of donor risk KDRI rather than relative measures of risk KDPI.

Original languageEnglish (US)
Pages (from-to)636-641
Number of pages6
JournalAmerican Journal of Transplantation
Issue number5
StatePublished - May 2023

Bibliographical note

Publisher Copyright:
© 2022 American Society of Transplantation & American Society of Transplant Surgeons


  • disparities
  • donors and donation: extended criteria
  • health services and outcomes research
  • organ procurement and allocation
  • Donor Selection
  • Humans
  • Graft Survival
  • Transplants
  • Kidney Transplantation
  • Retrospective Studies
  • Tissue Donors
  • Kidney

PubMed: MeSH publication types

  • Journal Article
  • Research Support, U.S. Gov't, P.H.S.


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