{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T18:34:51Z","timestamp":1787682891259,"version":"build-2784847793"},"reference-count":23,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2022,9,22]],"date-time":"2022-09-22T00:00:00Z","timestamp":1663804800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The United States organ allocation policies prioritize kidney\u2013pancreas and other multiorgan candidates above pediatric kidney\u2010alone candidates, but the effects of these policies are unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used OPTN data to describe trends in multiorgan and kidney\u2013pancreas transplantation and identify 377 next\u2010sequential pediatric kidney\u2010alone candidates between 4\/1\/2015 and 10\/31\/2019 for individual\u2010level analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eleven percent of all kidneys were allocated as part of a multiorgan or kidney\u2013pancreas transplant and 6% of pediatric kidney candidates were impacted. Pediatric next\u2010sequential candidates accrued a median of 118\u2009days (IQR 97\u2013135\u2009days) of additional wait time, and this was significantly longer for children who were Hispanic (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.02), blood type B or O (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.01), or had a cPRA \u226520% (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.01). Eight pediatric next\u2010sequential candidates (2%) were removed from the waitlist due to death or \u201ctoo sick to transplant.\u201d 63% were transplanted with a kidney with a higher KDPI than the original multiorgan match (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.01). Donor service areas with higher volumes of kidney\u2013pancreas transplants had significantly longer additional wait times for pediatric next\u2010sequential candidates (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Current allocation policy results in longer waiting times and higher KDPI kidneys for pediatric kidney candidates. As multiorgan transplant volume is increasing, further consideration of allocation policy is necessary to maximize equality and utility.<\/jats:p><\/jats:sec>","DOI":"10.1111\/petr.14394","type":"journal-article","created":{"date-parts":[[2022,9,22]],"date-time":"2022-09-22T10:32:17Z","timestamp":1663842737000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Impact of multiorgan and kidney\u2013pancreas allocation policies on pediatric kidney\u2010alone transplant candidates in the United States"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0584-7951","authenticated-orcid":false,"given":"Rachel","family":"Engen","sequence":"first","affiliation":[{"name":"Department of Pediatrics Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Shepherd","sequence":"additional","affiliation":[{"name":"Ann &amp; Robert H Lurie Children's Hospital of Chicago  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3385-0541","authenticated-orcid":false,"given":"Miranda C.","family":"Bradford","sequence":"additional","affiliation":[{"name":"Core for Biostatistics, Epidemiology, and Analytics in Research Seattle Children's Research Institute  Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Foutz","sequence":"additional","affiliation":[{"name":"United Network for Organ Sharing  Richmond Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4475-9751","authenticated-orcid":false,"given":"Sharon M.","family":"Bartosh","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Wisconsin Madison  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0365-4267","authenticated-orcid":false,"given":"Jodi M.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Washington  Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,9,22]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"OPTN.National data.https:\/\/optn.transplant.hrsa.gov\/data\/view\u2010data\u2010reports\/national\u2010data\/#. Accessed October 15 2021."},{"key":"e_1_2_9_3_1","volume-title":"Ethical Implications of Multi\u2010Organ Transplants OPTN Ethics Committee","author":"OPTN","year":"2019"},{"key":"e_1_2_9_4_1","volume-title":"Policies: Wait List, Organ Offers, and Allocation","author":"Trillium Gift of Life Network","year":"2019"},{"key":"e_1_2_9_5_1","unstructured":"NHS Blood and Transplant.POL200\/5\u2010introduction to patient selection and organ allocation policies controlled if copy number stated on document and issued by QA.2021. Published Online."},{"key":"e_1_2_9_6_1","unstructured":"OPTN.Ethical principles of pediatric organ allocation.https:\/\/optn.transplant.hrsa.gov\/resources\/ethics\/ethical\u2010principles\u2010of\u2010pediatric\u2010organ\u2010allocation\/. Accessed June 23 2021."},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-007-0631-y"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2014.323"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/S00467-005-1889-6"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.09751110"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2012.09.024"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1432-2277.2011.01400.x"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3046.2010.01359.x"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16390"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-006-0040-7"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.09751110"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1523-1755.2004.00805.x"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s004670000335"},{"key":"e_1_2_9_19_1","unstructured":"OPTN.EPTS Calculator.https:\/\/optn.transplant.hrsa.gov\/resources\/allocation\u2010calculators\/epts\u2010calculator\/. Accessed June 23 2021."},{"key":"e_1_2_9_20_1","volume-title":"Eliminate the Use of DSA and Region from Pancreas Allocation Policy","author":"Optn","year":"2019"},{"key":"e_1_2_9_21_1","unstructured":"Electronic Code of Federal Regulations (eCFR).https:\/\/www.ecfr.gov\/cgi\u2010bin\/text\u2010idx?SID=bb60e0a7222f4086a88c31211cac77d1&mc=true&node=pt42.1.121&rgn=div5#se42.1.121_18. Accessed June 23 2021."},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/tri.13892"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12902-020-0506-9"},{"key":"e_1_2_9_24_1","unstructured":"[USC05].42 USC 274: organ procurement and transplantation network.https:\/\/uscode.house.gov\/view.xhtml?req=. Accessed June 23 2021. (Title:42 section:274 edition:prelim)."}],"container-title":["Pediatric Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.14394","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/petr.14394","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.14394","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,28]],"date-time":"2024-08-28T10:02:58Z","timestamp":1724839378000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/petr.14394"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,22]]},"references-count":23,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["10.1111\/petr.14394"],"URL":"https:\/\/doi.org\/10.1111\/petr.14394","archive":["Portico"],"relation":{},"ISSN":["1397-3142","1399-3046"],"issn-type":[{"value":"1397-3142","type":"print"},{"value":"1399-3046","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,22]]},"assertion":[{"value":"2022-04-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-09-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-09-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e14394"}}