Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Jun 24, 2015; 5(2): 38-43
Published online Jun 24, 2015. doi: 10.5500/wjt.v5.i2.38
Changing organ allocation policy for kidney transplantation in the United States
Bhavna Chopra, Kalathil K Sureshkumar
Bhavna Chopra, Kalathil K Sureshkumar, Division of Nephrology and Hypertension, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA 15212, United States
Author contributions: Chopra B contributed to literature search, writing of the manuscript; Sureshkumar KK contributed to literature search, writing of the manuscript.
Conflict-of-interest: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kalathil K Sureshkumar, MD, FRCP (Glasgow), FASN, Division of Nephrology and Hypertension, Department of Medicine, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212, United States. ksureshk@wpahs.org
Telephone: +1-412-3593319 Fax: +1-412-3594136
Received: January 22, 2015
Peer-review started: January 26, 2015
First decision: February 7, 2015
Revised: February 14, 2015
Accepted: March 16, 2015
Article in press: March 18, 2015
Published online: June 24, 2015
Abstract

The new kidney allocation scheme (KAS) in effect since December 4th 2014 was designed to overcome the shortcomings of previous system. A key feature of the new KAS is preferential allocation of best quality organs to wait-list candidates with the longest predictive survival in a concept called longevity matching. Highly sensitized recipients would get extra points and enjoy widespread sharing of organs in order to increase accessibility to transplant. Wait-list candidates with blood group B will be offered organs from donors with A2 and A2B blood type in order to shorten their wait-list time. Time on the wait list will start from day of listing or date of initiation of dialysis whichever comes first which should benefit candidates with limited resources who might be late to get on the transplant list. Pay back system has been eliminated in the new KAS. These changes in organ allocation policy may lead to increase in median half-life of the allograft and increase the number of transplants; thus resulting in better utilization of a scarce resource. There could be unintended negative consequences which may become evident over time.

Keywords: New kidney allocation scheme, Longevity matching, Highly sensitized, Kidney donor profile index, Expected post-transplant survival

Core tip: The new kidney allocation system (KAS) was recently implemented in the United States in an attempt to improve the utilization of deceased donor kidneys. A key feature is preferential allocation of best quality organs to wait-list candidates with the longest predictive survival in a concept called longevity matching. Attempts were also made to improve access to kidney transplantation by giving priority points to highly-sensitized recipients and by giving consideration to dialysis vintage. Simulation model has predicted a modest increase in median allograft and patient life-years with the new KAS. Potential limitations and unintended consequences are also discussed in the article.