Purpose The HSP Kidney export threshold adjustment project is in progress, with the goal of ensuring the continuous, effective operation of the HSP Kidney sharing program. This will help ensure that the benefits of this interprovincial sharing program are realized for difficult to match candidates, including highly sensitized patients, medically urgent (2MU) candidates, and pediatric candidates. Many programs have reached or exceeded their export threshold, preventing eligible patients from receiving offers and preventing the program from operating as intended. To address this, the HSP Kidney operations team has worked with provincial partners to devise a plan to temporarily expand the export threshold limits, ensuring a normal flow of interprovincial offers for the next 6 months at minimum. The data that will be collected will help to inform a future long-term solution. Rationale At its inception in 2013, the HSP Kidney program had interprovincial balancing import and export thresholds in place to ensure that no region or province brings in or sends out too many kidneys, proportional to their populations. By 2016, all provinces agreed to update threshold limits and remove the Import threshold to ensure that highly sensitized candidates do not miss their chance at getting a rare match. Then in 2018 the provinces also agreed to make another exception and continue to export kidneys interprovincially for HSP candidates with a cPRA greater than 99.5%, even if at their export threshold limit. Slowly over time, however, these choices caused export thresholds in most provinces to be reached and thus greatly reduced the flow of interprovincial HSP kidney offers. Action was required to devise a new structure and long-term solution. What is the scope of the project? IN SCOPE OUT OF SCOPE POLICY & PROGRAM CHANGES Support implementation activities related to the threshold adjustment. Update and translate applicable policies, procedures, and supporting documentation. Broader redesign of the HSP Program. Updates to policy document during the interim adjustment of the HSP export thresholds. Changes to patient eligibility criteria.  Changes to clinical allocation or matching rules unrelated to export thresholds.  Review of other national organ-sharing policies outside the scope of export threshold removal.  DIGITAL & TECHNOLOGY Update provincial export threshold values within the CTR. Development of new interprovincial organ sharing allocation algorithms. Major enhancements or redesign of the CTR. Changes to local provincial allocation systems New integrations, interfaces or web services development. Who is impacted by the change and what does it mean to them? If the provinces are not making interprovincial offers, there is no sharing program. The primary objective, therefore, is to ensure that interprovincial HSP Kidney offers continue to be made unincumbered by threshold policy. This allows renal transplant programs to confidently register candidates into the program, maintaining the promise of access to a national deceased donor pool. Participating kidney candidates will rest assured their participation in the program, and the potential benefits thereof, is real. The threshold changes will also provide more certainty for provincial organ donations organizations (ODOs) who are responsible for allocating donor kidneys. What is Changing and How Does it Work? The Canadian Transplant Registry will be re-configured with the expanded threshold limit values as described below. This is a low-risk configuration change to the Canadian Transplant Registry (CTR) and is not anticipated to cause any changes to workflows or require any digital development to the CTR or your local allocation systems that interact with the CTR. PROVINCE/REGION NEW TEMPORARY EXPORT THRESHOLD PREVIOUS THRESHOLD BRITISH COLUMBIA -12 -3 ALBERTA -7 -2 SASKATCHEWAN -9 -1 MANITOBA -11 -1 ONTARIO -28 -12 QUEBEC -16 -8 ATLANTIC CANADA -8 -4 Table 1 - New Export Thresholds 1- No change for Manitoba as they are not modelled to reach export threshold limitation for the next six months. Now that most provinces will now be beneath their export threshold, CTR Donor Coordinators running the HSP kidney allocations will no longer be presented with a warning message advising them of being at their provincial/regional limit. The visual warning message will, of course, return if the ODO’s export limit is reached again in the future. Though none are anticipated, provincial ODOs running HSP allocations from a local organ allocation system will need to verify for impacts to their technology, local workflows, educational materials, and/or policies are updated to align. When importing an HSP program kidney, renal transplant programs need to record the recipient’s transplant result in CTR as soon as is possible. This is what triggers the CTR to apply an Import point for your region, and operationally, helps ensure provinces stay closer to balance on the general ledger. Likewise, after organ recovery, offering ODOs should ensure they record that the donor’s kidney is ‘Sent for Transplant’ in CTR to ensure the CTR applies the exportation point for your province/region. What are the expected implementation timelines? The Canadian Blood Services IPOS team in collaboration with Provincial stakeholders will release the changed configuration along the following timeline: 1. Partner IT Communication: September 21, 2026 Our Release Manager will reach out to all IT partners to communicate the planned change and provide any implementation details that may be required. 2. Configuration Change in User Acceptance Testing (UAT) Environment: October 1, 2026 The updated threshold values will be configured in the UAT environment. 3. Stakeholder Testing: October 5 – October 9, 2026 Stakeholders will have the opportunity to validate the configuration update in UAT environment. 4. Implementation Canadian Transplant Registry: Tuesday, October 13, 2026 The threshold values will be updated in the Canadian Transplant Registry. Implementation is scheduled for 6:00 AM ET, consistent with previous CTR changes. How to get in touch Please email ctr.ipos@blood.ca if you have project related questions. Frequently asked questions Why are we doing this? To unblock interprovincial kidney sharing for IPOS HSP program. How was this project governed and how were decisions made? The changes were endorsed by the Kidney Transplant Advisory Committee, and through rigorous consultations and negotiations with provincial ODOs and transplant program representatives, the new thresholds were agreed upon for implementation. We will continue to work with them to devise a long-term solution. Who approved the adjustment? Provincial Organ Donation Organizations collectively agreed to implement the updated thresholds. How were these thresholds derived? We used each province's current general ledger score, subtracted their worst 6-month score-drop in history, and subtracted one more to ensure that if the province experienced its worst 6 months on-record, they'd still have threshold room. What is the “worst 6-month score-drop”? Any 6 months stretch a province had, since July 2017, that produced the largest negative balance change over that time. Won’t export threshold thresholds lock up again at a later date? The data that will be gathered will be used to inform a longer-term balanced solution with the goal of maintaining flow of interprovincial offers and transplants.