New national effort seeks a more rational organ allocation system for kidney transplants


SEATTLE, Wash. -- More than 60,000 Americans are on the waiting list for a donated kidney to save their lives, and the United Network for Organ Sharing (UNOS) is responding to the shortage of deceased-donor organs by reviewing the complex formula that has guided kidney allocation for years. One possible outcome of the review announced this week at the annual American Transplant Congress is that the allocation formula will likely include new factors related to both the donor and the recipient not included in the current system.

"With so many people waiting for kidneys from deceased donors, UNOS wisely recognizes that it's time to review guidelines to assure we are making the best possible use of scarce and life-giving resources," says Mayo Clinic transplant surgeon Mark Stegall, M.D., who chairs the group.

The review group, the Kidney Allocation Review Subcommittee, is a nationwide collaboration of transplant specialists who have been reviewing allocation issues for months and soliciting input from the public. In announcing its preliminary findings this week, the group emphasizes its embrace of both collaboration and public comment. To participate in the process, members of the public are invited to e-mail UNOS at, under the "contact" section.

The public review comment extends through summer and possibly fall 2005. The UNOS board is expected to receive any kidney allocation guideline changes in November 2005 or June 2006.

Open Process Helps Identify Solutions to Tough Questions
Hearings to date have addressed many difficult issues involved in kidney transplantation. Among them are: ethical issues; barriers that may prevent patients from having equitable access to the organ allocation system; medical issues about tissue typing and immune system profiles that determine whether an organ will be accepted or rejected; and a review of kidney allocation systems in other countries. Says Dr. Stegall, "The goal in carefully analyzing all these issues in an open and inclusive process is to improve the lives of patients with end-stage renal disease by assuring the just and optimal use of deceased donor kidneys. There will likely be changes to the allocation guidelines down the line, and they will be changes based on multiple things we can do to improve the lives of patients."

An Example of Possible Changes Under Discussion
One possible change that could affect the allocation formula is to consider that each kidney has a different biological life expectation that may better biologically suit it to one person than another.

Three-pronged Allocation Approach
A major concern of patients who need liver transplants is that many die while on the waiting list for a donated liver. Wait-list mortality is less of an issue for kidney patients because their disease can be compensated for with dialysis. But kidney transplantation brings its own issues, which have given rise to the three-pronged allocation approach the review committee unveils today.

  • Justice. Assuring equitable access to transplantation.
  • Utility. Maximizing organ and patient survival.
  • Efficiency. Decreasing the number of organs that are wasted due to misplacement or mismatches.

    The Next Step
    A computer model is testing some proposed changes that surfaced during the open hearing process. The data from these tests, coupled with hearing input, will be forwarded to the UNOS board to help guide any allocation formula changes. Says Dr. Stegall, "The key issue here is that this is an ongoing process that welcomes input from all areas. We have some ideas of the changes needed -- and we'd like to hear more ideas."

    Source: Eurekalert & others

    Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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