OPTN Policies, Policy 8: Allocation of Kidneys

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8.2 Kidney Allocation Score Candidates receive an allocation score according to the total of all points assigned in Table 8-1. Table 8-1: Kidney Points If the candidate is: And the following allocation Then the candidate receives sequence is used: this many points: Registered for transplant and 8.4.I, 8.4.J, 8.4.K, or 8.4.L 1/365 points for each day since meets the qualifying criteria the qualifying criteria in Policy described in Policy 8.3: Waiting 8.3: Waiting Time Time Aged 0-10 at time of match and 8.4.I, 8.4.J, or 8.4.K 4 points a 0-ABDR mismatch with the donor Aged 11-17 at time of match 8.4.I, 8.4.J, or 8.4.K 3 points and a 0-ABDR mismatch with the donor Aged 0-10 at time of match and 8.4.I, 8.4.J 1 point donor has a KDPI score <35% Effective Date: 11/13/2025 Page 151 If the candidate is: And the following allocation Then the candidate receives sequence is used: this many points: A prior living donor 8.4.I, 8.4.J, or 8.4.K 4 points Sensitized (CPRA at least 20%) 8.4.I, 8.4.J, or 8.4.K See Table 8-2: Points for CPRA A single HLA-DR mismatch with 8.4.I, 8.4.J, or 8.4.K 1 point the donor* A zero HLA-DR mismatch with 8.4.I, 8.4.J, or 8.4.K 2 points the donor* Meets the qualifying criteria 8.4.I, 8.4.J, 8.4.K, or 8.4.L See Table 8-3: Points for described in Table 8-3: Points Allocation of Kidneys based on for Allocation of Kidneys based Proximity to Donor Hospital on Proximity to Donor Hospital *Donors with only one antigen identified at an HLA locus (A, B, and DR) are presumed “homozygous” at that locus.

Referencing norms: Table81Points, WaitingTimePoints

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8.4.C Sorting Within Each Classification For candidates within classifications 1 through 7 according to Tables 8-7 and 8-8; classifications 1 through 6 according to Table 8-9, and classifications 1 through 5 according to Table 8-10, candidates are sorted in the following order: 1. Medical urgency status 2. Total time at medically urgent status for current medically urgent candidates only (highest to lowest) 3. Total points (highest to lowest) 4. Date and time of the candidate’s registration (oldest to most recent) For candidates within all other classifications, candidates are sorted in the following order: 1. Total points (highest to lowest) 2. Date and time of the candidate’s registration (oldest to most recent) 8.4.D Allocation of Kidneys by Blood Type Transplants are restricted by blood type in certain circumstances. Kidneys will be allocated to candidates according to the blood type matching requirements in Table 8-6 below: Table 8-6: Allocation of Kidneys by Blood Type Kidneys from Donors with: Are Allocated to Candidates with: Blood Type O Blood type O. For offers made to candidates in 0-ABDR mismatch categories, blood type O kidneys may be transplanted into candidates who have blood types other than O. Blood Type A Blood type A or blood type AB. Blood Type B Blood type B. For offers made to candidates in 0-ABDR mismatch categories, blood type B kidneys may be transplanted into candidates who have blood types other than B. Blood Type AB Blood type AB. Blood Types A, non-A1 and AB, non-A1B Kidneys may be transplanted into candidates with blood type B who meet all of the following criteria: 1. The transplant program obtains written informed consent from each blood type B candidate regarding their willingness to accept a blood Effective Date: 11/13/2025 Page 158 Kidneys from Donors with: Are Allocated to Candidates with: type A, non-A1 or blood type AB, non- A1B blood type kidney. 2. The transplant program establishes a written policy regarding its program’s titer threshold for transplanting blood type A, non-A1 and blood type AB, non-A1B kidneys into candidates with blood type B. The transplant program must confirm the candidate’s eligibility every 90 days (+/- 20 days). 8.4.E Prior Living Organ Donors A kidney candidate will be classified as a prior living donor if all of the following conditions are met: 1. The candidate donated for transplantation, within the United States or its territories, at least one of the following: • Kidney • Liver segment • Lung segment • Partial pancreas • Small bowel segment. 2. The candidate’s physician reports all of the following information to the OPTN: a. The name of the recipient or intended recipient of the donated organ or organ segment b. The recipient’s or intended recipient’s transplant hospital c. The date the donated organ was procured

Referencing norms: BloodTypeABNonA1BToB, BloodTypeANonA1ToB, BloodTypeAToAB, BloodTypeIdentity, BloodTypeZeroAbdrFromB, BloodTypeZeroAbdrFromO, NonA1ConditionsMet, PriorLivingDonorClassification, RankByPoints, RankByPointsOtherClassifications, RankByRegistration, RankByUrgency, RankByUrgentTime, SameClassificationConverse, SameClassificationForward, TableForKdpiAbove85, TableForKdpiAtMost20, TableForKdpiBelow35, TableForKdpiUpTo85, TiedPointsEqual, TiedPointsOtherClassifications, TiedUrgencyBothUrgent, TiedUrgencyNeitherUrgent, TiedUrgentTimeEqual, TiedUrgentTimeNotApplicable, UrgencyFirstTable810, UrgencyFirstTable87, UrgencyFirstTable88, UrgencyFirstTable89

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Table 8-2: Points for CPRA If the candidate’s CPRA score is: Then the candidate receives this many points: 0 0.00 1-9 0.00 10-19 0.00 20-29 0.08 30-39 0.21 40-49 0.34 50-59 0.48 60-69 0.81 70-74 1.09 75-79 1.58 80-84 2.46 85-89 4.05 90-94 6.71 95 10.82 96 12.17 97 17.30 98 24.40 99 50.09 100 202.10 Effective Date: 11/13/2025 Page 152

Referencing norms: CpraPoints_0_0, CpraPoints_100_100, CpraPoints_10_19, CpraPoints_1_9, CpraPoints_20_29, CpraPoints_30_39, CpraPoints_40_49, CpraPoints_50_59, CpraPoints_60_69, CpraPoints_70_74, CpraPoints_75_79, CpraPoints_80_84, CpraPoints_85_89, CpraPoints_90_94, CpraPoints_95_95, CpraPoints_96_96, CpraPoints_97_97, CpraPoints_98_98, CpraPoints_99_99

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Table 8-3: Points for Allocation of Kidneys based on Proximity to Donor Hospital For purposes of this section, distance is calculated in nautical miles between candidate’s hospital of registration and the donor hospital. If the candidate is: Then the candidate receives this many points: Registered at a transplant program that is 250 nautical miles or less away from 2 2 − [( ) × 𝑑𝑖𝑠𝑡𝑎𝑛𝑐𝑒] the donor hospital 250 − 0 Registered at a transplant program that is more than 250 nautical miles away 4 4 − [(( ) × 𝑑𝑖𝑠𝑡𝑎𝑛𝑐𝑒 ) from but 2500 nautical miles or less away 2500 − 250 from the donor hospital 250 − (4 × )] 2500 − 250 Registered at a transplant program that 0 is more than 2500 nautical miles away from the donor hospital Table 8-4: Points for Released Kidneys based on Proximity to Transplant Hospital that Originally Accepted the Organ For purposes of this section, distance is calculated in nautical miles between the candidate’s hospital of registration and the transplant hospital that released the kidney. If the candidate is: Then the candidate receives this many points: Registered at a transplant hospital that is 250 2 nautical miles or less away from the transplant 2 − [( 250 − 0 ) × 𝑑𝑖𝑠𝑡𝑎𝑛𝑐𝑒] hospital that originally accepted the kidney Registered at a transplant hospital that is more than 250 nautical miles but 2,500 nautical miles 4 250 4 − [(( ) × 𝑑𝑖𝑠𝑡𝑎𝑛𝑐𝑒 ) − (4 × )] 2500 − 250 2500 − 250 or less away from the transplant hospital that originally accepted the kidney Registered at a transplant hospital that is more than 2,500 nautical miles away from the 0 transplant hospital that originally accepted the kidney Effective Date: 11/13/2025 Page 153

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Table 8-7: Allocation of Kidneys from Deceased Donors with KDPI Less Than or Equal To 20% And registered at a transplant hospital that is at or within With this donor Classification Candidates that are this distance from blood type: the hospital that distribution will be based upon 0-ABDR mismatch, CPRA 1 equal to 100%, blood type 250NM Any identical or permissible CPRA equal to 100%, blood 2 250NM Any type identical or permissible 0-ABDR mismatch, CPRA 3 equal 100%, blood type Nation Any identical or permissible CPRA equal to 100%, blood 4 Nation Any type identical or permissible Prior living donor, blood 5 250NM Any type identical or permissible Registered prior to 18 years 6 old, blood type identical or 250NM Any permissible 7 Medically Urgent 250NM Any 0-ABDR mismatch, CPRA 8 equal to 99%, blood type 250NM Any identical or permissible CPRA equal to 99%, blood 9 250NM Any type identical or permissible Effective Date: 11/13/2025 Page 162 And registered at a transplant hospital that is at or within With this donor Classification Candidates that are this distance from blood type: the hospital that distribution will be based upon 0-ABDR mismatch, CPRA 10 equal to 98%, blood type 250NM Any identical or permissible CPRA equal to 98%, blood 11 250NM Any type identical or permissible 0-ABDR mismatch, top 20% 12 EPTS, and blood type 250NM Any identical 0-ABDR mismatch, top 20% EPTS, CPRA greater than or 13 Nation Any equal to 80%, and blood type identical 0-ABDR mismatch, less than 18 years old at time of match, CPRA greater than or 14 Nation Any equal to 21% but no greater than 79%, and blood type identical 0-ABDR mismatch, less than 18 years old at time of match, CPRA greater than or 15 Nation Any equal to 0% but less than or equal to 20%, and blood type identical 0-ABDR mismatch, top 20% EPTS, CPRA greater than or 16 equal to 21% but no greater Nation Any than 79%, and blood type identical 0-ABDR mismatch, top 20% 17 250NM O EPTS, and blood type B Effective Date: 11/13/2025 Page 163 And registered at a transplant hospital that is at or within With this donor Classification Candidates that are this distance from blood type: the hospital that distribution will be based upon 0-ABDR mismatch, top 20% EPTS or less than 18 years at 18 time of match run, CPRA Nation O greater than or equal to 80%, and blood type B 0-ABDR mismatch, less than 18 at time of match, CPRA 19 greater than or equal to 21% Nation O but no greater than 79%, and blood type B 0-ABDR mismatch, less than 18 at time of match, CPRA 20 greater than or equal to 0% Nation O but less than or equal to 20%, and blood type B 0-ABDR mismatch, top 20% EPTS, CPRA greater than or 21 Nation O equal to 21% but no greater than 79%, and blood type B 0-ABDR mismatch, top 20% 22 EPTS, and blood type 250NM Any permissible 0-ABDR mismatch, top 20% EPTS, CPRA greater than or 23 Nation Any equal to 80%, and blood type permissible 0-ABDR mismatch, less than 18 years old at time of match run, CPRA greater 24 Nation Any than or equal to 21% but no greater than 79%, and blood type permissible 0-ABDR mismatch, less than 18 years old at time of match run, CPRA greater 25 Nation Any than or equal to 0% but less than or equal to 20%, and blood type permissible Effective Date: 11/13/2025 Page 164 And registered at a transplant hospital that is at or within With this donor Classification Candidates that are this distance from blood type: the hospital that distribution will be based upon 0-ABDR mismatch, top 20% EPTS, CPRA greater than or 26 equal to 21% but no greater Nation Any than 79%, and blood type permissible 27 Top 20% EPTS, blood type B 250NM A2 or A2B Top 20% EPTS, blood type 28 250NM Any identical or permissible 0-ABDR mismatch, EPTS 29 greater than 20%, blood 250NM Any type identical 0-ABDR mismatch, EPTS greater than 20%, CPRA 30 greater than or equal to Nation Any 80%, and blood type identical 0-ABDR mismatch, EPTS greater than 20%, CPRA 31 greater than or equal to 21% Nation Any but no greater than 79%, and blood type identical 0-ABDR mismatch, EPTS 32 greater than 20%, and blood 250NM O type B 0-ABDR mismatch, EPTS greater than 20%, CPRA 33 Nation O greater than or equal to 80%, and blood type B 0-ABDR mismatch, EPTS greater than 20%, CPRA 34 greater than or equal to 21% Nation O but no greater than 79%, and blood type B Effective Date: 11/13/2025 Page 165 And registered at a transplant hospital that is at or within With this donor Classification Candidates that are this distance from blood type: the hospital that distribution will be based upon 0-ABDR mismatch, EPTS 35 greater than 20%, and blood 250NM Any type permissible 0-ABDR mismatch, EPTS greater than 20%, CPRA 36 greater than or equal to Nation Any 80%, and blood type permissible 0-ABDR mismatch, EPTS greater than 20%, CPRA 37 greater than or equal to 21% Nation Any but no greater than 79%, and blood type permissible EPTS greater than 20%, 38 250NM A2 or A2B blood type B All remaining candidates, 39 blood type identical or 250NM Any permissible Registered prior to 18 years 40 old, blood type identical or Nation Any permissible 41 Top 20% EPTS, blood type B Nation A2 or A2B Top 20% EPTS, blood type 42 Nation Any identical or permissible All remaining candidates, 43 blood type identical or Nation Any permissible Effective Date: 11/13/2025 Page 166 8.4.J Allocation of Kidneys from Deceased Donors with KDPI Scores Greater Than 20% but Less Than 35% Kidneys from deceased donors with KDPI scores greater than 20% but less than 35% are allocated to candidates according to Table 8-8 below. For the purposes of Table 8-8, distribution will be based on the distance from the candidate’s transplant hospital to the donor hospital, unless the kidney is allocated according to OPTN Policy 8.7: Allocation of Released Kidneys. For kidneys that are released and the host OPO or the OPTN executes a released kidney match run, distribution will be based on the distance from the candidate’s transplant hospital to the transplant hospital that released the organ.

Referencing norms: BloodTypeIdenticalMatch, Classification1, Classification10, Classification11, Classification12, Classification13, Classification14, Classification15, Classification16, Classification2, Classification3, Classification4, Classification5, Classification6, Classification7, Classification8, Classification9