A 100-year simulation of the National Kidney Registry’s voucher program

The National Kidney Registry's voucher program provides a novel methodology to increase directed and nondirected living kidney donation. Standard vouchers, launched in 2014, allow a donor to donate to an unknown recipient on behalf of an individual who needs a transplant. Family vouchers (FVs), launched in 2019, allow a Good Samaritan donor to donate and provide vouchers to loved ones who do not have end-stage renal disease. To date, there have been 15 FV redemptions with over 5000 voucher holders. To assure the continued viability of the voucher program, a 100-year Monte Carlo simulation model was performed using demographic data from the existing and past donors and voucher holders. Four projected scenarios of program activity were simulated. In all scenarios, there were enough available kidneys to cover all predicted voucher redemptions. For the "Most Likely" scenario, the simulation model projects 390 000 new donors and only 300 000 voucher redemptions. Additionally, the model projects only 3700 FV redemptions compared to 94 000 new FV donors over 100 years. This simulation demonstrates that the voucher program should be able to satisfy the likely redemption of vouchers under a range of scenarios over a 100-year time horizon.