- Confirm the kidney is from a deceased donor — KDRI/KDPI do not apply to living donors.
- Enter the donor's age, height (cm), weight (kg), and serum creatinine (mg/dL). These are required; the index updates automatically as you type.
- Set the yes/no factors: African-American ethnicity, history of hypertension, history of diabetes, cause of death = CVA/stroke, HCV positive, and donation after circulatory death (DCD).
- Read off the three result cards: KDRI (median-scaled), KDPI (%), and the quality tier (KDPI 0–20% best · 21–85% standard · >85% higher-risk). Lower KDPI = better expected graft longevity.
All computation runs in your browser; no values are stored or transmitted. This tool uses the legacy Rao 2009 / OPTN ten-variable KDRI with the 2024 OPTN scaling factor (1.309009) and KDRI→KDPI mapping table.
When to Use
Use KDRI/KDPI when evaluating a deceased-donor kidney offer to quantify donor quality and expected graft longevity relative to all U.S. recovered deceased-donor kidneys. KDPI is central to the Kidney Allocation System (KAS): low-KDPI kidneys (≤20%) are longevity-matched to candidates with the best expected post-transplant survival (low EPTS), while high-KDPI kidneys (>85%) require informed consent and are offered through an expanded allocation sequence. The index helps a transplant team and an informed recipient weigh the risk–benefit of accepting a given organ rather than waiting.
Appropriate use
Deceased-donor kidneys only. Most useful at the moment of organ offer for shared decision-making, for pairing KDPI with the candidate's EPTS, and for documenting why a high-KDPI offer was accepted or declined. The ten inputs come straight from the donor record (UNOS DonorNet).
When NOT to rely on it
KDRI/KDPI do not apply to living donors. They are population-level estimates of relative graft-failure risk, not a guarantee for an individual kidney, and they do not incorporate biopsy findings, machine-perfusion parameters, cold-ischemia time, anatomy, or recipient factors. The percentile depends on the reference year — this tool uses the 2024 OPTN mapping; the live OPTN calculator is updated annually and reflects current policy (which since October 2024 removed the race and HCV terms). For an exact, policy-current KDPI, use the official OPTN calculator.
Pearls & Pitfalls
KDRI vs KDPI — relative risk vs percentile
KDRI is a relative hazard: a median-scaled KDRI of 1.0 is the median donor, 1.5 means ~50% higher relative risk of graft failure than the median. KDPI simply re-expresses that KDRI as a percentile against the prior-year reference population: a KDPI of 85% means the donor's KDRI exceeds 85% of recovered donors. Lower is better for both.
What drives the number
The strongest upward drivers in the regression are older donor age, higher serum creatinine, HCV positivity, diabetes, hypertension, DCD, and death from CVA/stroke; taller and heavier donors carry slightly lower risk. Pair a high-KDPI offer with a thoughtful candidate match (e.g., older recipient, longer waitlist time) rather than rejecting it reflexively — a "marginal" kidney often still beats remaining on dialysis.
Pitfalls
(1) This implementation uses the legacy Rao 2009 ten-variable model (includes the race and HCV terms); OPTN removed the race and HCV factors in October 2024, so a current OPTN KDPI for the same donor may differ. (2) The KDPI percentile is reference-year-dependent — it is recalibrated every year; this tool is fixed to the 2024 table. (3) Use the donor's terminal/admission serum creatinine per OPTN convention, in mg/dL. (4) KDPI is not a substitute for biopsy, perfusion data, anatomy, or recipient-specific judgment. For allocation-grade numbers, always confirm with the official OPTN calculator.
Why Use It
Before KDRI/KDPI, deceased-donor kidneys were sorted crudely into "standard criteria" versus "expanded criteria" (ECD) — a blunt binary that lumped very different organs together. The KDRI introduced by Rao and colleagues in 2009 replaced that binary with a continuous, ten-variable estimate of graft-failure risk, and its percentile form (KDPI) became a cornerstone of the 2014 Kidney Allocation System. KDPI lets a transplant team and an informed patient put a single, comparable number on an organ offer — supporting longevity matching (low-KDPI kidneys to low-EPTS candidates), structured informed consent for higher-risk (KDPI >85%) offers, and consistent, defensible accept/decline decisions. For a patient facing the trade-off between accepting a "marginal" kidney now versus continued dialysis and waitlist mortality, that quantification is genuinely decision-changing.
KDPI / KDRI — Deceased-Donor Kidney Quality
Enter the ten donor factors. The Kidney Donor Risk Index (median-scaled), the Kidney Donor Profile Index (KDPI %), and the quality tier update automatically. Required: age, height, weight, serum creatinine. Uses the Rao 2009 / OPTN algorithm with the 2024 OPTN scaling factor (1.309009) and KDRI→KDPI mapping table.
⚕ KDRI per Rao PS et al., Transplantation 2009;88(2):231–236; KDPI mapped with the OPTN 2024 scaling factor (1.309009) and KDRI→KDPI mapping table (legacy ten-variable model, including the race and HCV terms OPTN retired in October 2024). KDPI is reference-year-dependent and is recalibrated annually — for an exact, policy-current value use the official OPTN KDPI calculator. Deceased donors only; not a substitute for biopsy, perfusion data, or recipient-specific judgment.
Next Steps
Use the KDPI tier to frame the organ offer and the next conversation.
- KDPI 0–20% (best-quality): longevity-matched under KAS to candidates with the lowest EPTS (best expected post-transplant survival). Prioritize for younger or longest-expected-survival recipients.
- KDPI 21–85% (standard): the majority of offers. Weigh against the candidate's waitlist time, sensitization, and dialysis vintage; for most candidates these kidneys clearly outperform staying on dialysis.
- KDPI >85% (higher-risk): requires documented informed consent and is offered through the expanded allocation sequence. Often a sound choice for an older candidate or one facing prolonged wait — still typically better than continued dialysis.
- Pair KDPI with EPTS (recipient survival) for longevity matching, and follow the graft afterward with the allograft eGFR trend tool. For an allocation-grade, policy-current number, confirm with the official OPTN KDPI calculator.
Evidence & References
KDRI regression (Rao 2009, Xβ contributions)
| Donor factor | Contribution to Xβ |
|---|---|
| Age | 0.0128 × (age − 40); if age < 18 add −0.0194 × (age − 18); if age > 50 add 0.0107 × (age − 50) |
| Height | −0.0464 × (height − 170) / 10 |
| Weight | if weight < 80 kg: −0.0199 × (weight − 80) / 5 (else 0) |
| African-American | +0.1790 |
| History of hypertension | +0.1260 |
| History of diabetes | +0.1300 |
| Cause of death = CVA | +0.0881 |
| Serum creatinine | 0.2200 × (Scr − 1); if Scr > 1.5 add −0.2090 × (Scr − 1.5) |
| HCV positive | +0.2400 |
| DCD | +0.1330 |
| KDRIRao | exp(Σ Xβ) |
| KDRImedian | KDRIRao ÷ scaling factor (2024 OPTN = 1.309009) |
| KDPI | percentile of KDRImedian on the 2024 OPTN KDRI→KDPI mapping table |
KDPI interpretation tiers
| KDPI | Interpretation |
|---|---|
| 0–20% | Best-quality kidneys — longevity-matched to low-EPTS candidates under KAS |
| 21–85% | Standard-quality deceased-donor kidneys |
| >85% | Higher-risk — informed consent required; expanded allocation sequence |
Rao and colleagues derived the ten-variable KDRI from SRTR data to express deceased-donor graft-failure risk on a continuous scale; OPTN re-expresses the scaled KDRI as the KDPI percentile and recalibrates the scaling factor and mapping table annually. This page uses the 2024 OPTN values (scaling factor 1.309009 and the 2024 KDRI→KDPI mapping table). Since October 2024, OPTN's official KDPI has removed the donor race and HCV terms; the legacy ten-variable model here may therefore differ from a current OPTN result for the same donor.
References
- Rao PS, Schaubel DE, Guidinger MK, et al. A comprehensive risk quantification score for deceased donor kidneys: the kidney donor risk index. Transplantation. 2009;88(2):231–236. doi:10.1097/TP.0b013e3181ac620b.
- Organ Procurement and Transplantation Network (OPTN). A Guide to Calculating and Interpreting the Kidney Donor Profile Index (KDPI). OPTN/UNOS; 2024 update (scaling factor 1.40437 for the current race/HCV-free model; this tool uses the legacy ten-variable scaling factor 1.309009 from the same 2024 mapping table).
- Israni AK, Salkowski N, Gustafson S, et al. New national allocation policy for deceased donor kidneys in the United States and possible effect on patient outcomes. J Am Soc Nephrol. 2014;25(8):1842–1848. doi:10.1681/ASN.2013070784.
