OPTNKidney Donor Quality Assessment
Donor Characteristics
years
cm
kg
mg/dL
Terminal donor creatinine
KDPI Calculator
Enter donor characteristics to estimate kidney quality percentile.
Guidelines & Evidence
Verified
Last Review: 2026-07-17
When to Use
When to Use
To assess deceased donor kidney quality at the time of organ offer
To guide organ acceptance decisions in kidney transplantation
To implement longevity matching with the candidate EPTS score
To counsel recipients about expected graft survival from a given donor
To stratify donor quality for research and quality improvement
What the Score Means
When Not to Rely on This Score Alone
How it Works
KDRI Calculation
The KDPI is derived from the Kidney Donor Risk Index (KDRI), a Cox proportional hazards model that estimates the relative risk of graft failure for a given donor compared to the reference donor. The KDRI incorporates ten donor characteristics: age, height, weight, ethnicity, history of hypertension, history of diabetes, cause of death, serum creatinine, HCV serostatus, and DCD status.
KDRI to KDPI Mapping
KDRI = exp(linear predictor from Cox model)
KDPI = percentile of KDRI among all recovered deceased donor kidneys
KDPI = (rank of KDRI among all donors) / (total donors) × 100%
KDPI ≤ 20%: "Top 20%" — highest quality, priority allocation to EPTS ≤ 20% candidates
KDPI > 85%: Formerly "Expanded Criteria Donor (ECD)" threshold (replaced in 2014)
Key Donor Factors and Their Impact
01
Age: The dominant predictor — donor age > 50 substantially increases KDRI
02
Hypertension: History of hypertension increases risk by approximately 25%
03
Diabetes: Donor diabetes carries a large independent risk (~60% increase in hazard)
04
Serum Creatinine: Higher terminal creatinine is a marker of acute kidney injury or pre-existing kidney disease
05
DCD: Donation after circulatory death is associated with higher rates of delayed graft function
06
HCV Positive: Historically a strong risk factor; less relevant in the DAA therapy era
Clinical Pearls
ECD vs. KDPI
The KDPI replaced the binary "Standard Criteria Donor" vs. "Expanded Criteria Donor" (ECD) classification in 2014. ECD was defined as donor age ≥ 60, or age 50-59 with two of: hypertension, terminal Cr > 1.5, or CVA death. KDPI provides a continuous, more granular risk spectrum. KDPI > 85% approximates the old ECD threshold but includes many donors that would not have met ECD criteria (e.g., young donors with acute kidney injury).
Clinical Application Pearls
KDPI ≤ 20% kidneys are allocated to EPTS ≤ 20% candidates first — ensure candidate EPTS is current
High KDPI kidneys can provide substantial survival benefit compared to remaining on dialysis — especially for older or diabetic candidates
KDPI does not capture donor-recipient size mismatch, HLA matching, or cold ischaemia time — consider all factors
Kidney biopsy findings (glomerulosclerosis, interstitial fibrosis) provide additional information beyond KDPI
Many centres use KDPI 20-85% as the "standard offer" range with individualised acceptance decisions
Next Steps
Guiding Acceptance Decisions
01
KDPI ≤ 20%: Pursue for EPTS ≤ 20% candidates. Offers to other candidates by waiting time and CPRA.
02
KDPI 21–50%: Standard quality. Generally well-accepted. Good counselling point: "This kidney is expected to function longer than most."
03
KDPI 51–85%: Below-average quality but still beneficial for most candidates compared to dialysis.
04
KDPI > 85%: Discuss explicitly — higher risk of graft failure and delayed graft function. May be appropriate for older candidates or those with long anticipated wait times.
Survival Benefit Calculation
The survival benefit of kidney transplantation over remaining on dialysis is present at all KDPI levels, but the magnitude decreases as KDPI increases. For a 60-year-old diabetic candidate, even a 95% KDPI kidney provides a survival advantage over dialysis within approximately 2 years. For a 25-year-old non-diabetic candidate, accepting a high-KDPI kidney may reduce total lifetime survival compared to waiting for a lower-KDPI offer.
The Evidence
KDRI Original Derivation
A comprehensive risk quantification score for deceased donor kidneys: the kidney donor risk index.
Rao PS et al. • Transplantation.. 2009;88(2):231–236. n = 69,440. Derivation of the KDRI from SRTR data. C-statistic 0.62 for graft survival.
View SourceKDPI Implementation
Kidney Allocation System (KAS) implementation — KDPI mapping summary.
OPTN. • OPTN Policy 8: Allocation of Deceased Kidneys.. 2014;Effective December 4, 2014. KDPI replaces ECD classification in US allocation policy.
Origins & History
From ECD to KDPI
The KDPI was developed by the Scientific Registry of Transplant Recipients (SRTR) under the leadership of Dr. Vihn Bao and colleagues, building on the earlier KDRI work by Dr. Panduranga Rao. The 2014 policy change represented a major advance in donor quality assessment, replacing the crude ECD/SD binary with a continuous, evidence-based risk measure.
Last Comprehensive Review: 2026-07-17