Kidney Transplant Allocation Guidelines
There are more than 100,000 people on the waiting list for a kidney in the U.S. The average wait time for kidney recipients is more than three-and-a-half years. The system needs more people to become donors if there is any hope for those on the waiting list.
In addition to having too few donors, the United States' kidney transplant allocation system had become largely ineffective. With historically high discard rates, too many access variations, and mismatches in graft/patient survival, the system needed to be revised to improve the overall process and hopefully maximize outcomes for transplant recipients.
The Organ Donation Process
Before we outline the new policy, let’s look at how the system previously operated. For years, when a person donated his or her organs, these organs would go to an organ procurement organization that managed the event. The UNOS Computer System then handled the allocation of the organs to the transplant center, and ultimately, the patient.
Unfortunately, this was a particularly unbalanced process. The biggest problem was that waiting time became the primary driver of kidney allocation. Tissue matching also drove the allocation process, but that greatly diminished over time. Ultimately, this system only served to help those candidates who had been waiting the longest. It failed to acknowledge different needs of different candidates; for example, favoring speed over quality.
The New Kidney Allocation System
In 2003, discussions within the medical community began, petitioning to create a new policy for the kidney allocation system. Many advances were made over the next several years. Then, in December 2014, the new policy launched with the goals of:
- Making the most of every donated kidney without diminishing access
- Promoting graft survival for those at high risk of re-transplant
- Minimizing loss of potential graft function through better longevity matching
- Improving efficiency and utilization by providing better information about kidney offers
Additional Variables for Donor Kidneys
Under the previous kidney allocation guidelines, donor kidneys were graded using only a few variables, specifically age, creatinine levels, and the presence of hypertension or a cerebrovascular event.
With the new policy, more donor variables are considered when grading each kidney, including age, race/ethnicity, hypertension, diabetes, serum creatinine, COD CVA, height, weight, DCD and HCV. Depending on how they score, donor kidneys are then categorized into sequence A, B, C, or D.
New Kidney Recipient Guidelines
Under the new guidelines, kidney recipients will be evaluated based on the following conditions:
- Estimated post-transplant survival (EPTS), which looks at candidate age, time on dialysis prior to organ transplant, diabetes status. This is more predictive than age alone.
- EPTS score must be in the top 20 percent (even at age 50) to receive a donated kidney that’s categorized in the top 20 percent.
The goal with these new guidelines is to match the top kidney transplant candidates with the best donor kidneys, which will give them the best chance for long-term survival.
Projected Outcomes with New Policy
The new kidney transplant allocation policy is expected to create the following outcomes:
- 8,380 additional life years gained annually
- Improved access for moderately and very highly sensitized candidates
- Improved access for ethnic minority candidates
- Comparable levels of kidney transplants at regional/national levels
- Reduced discard rates
- “Waiting” begins at dialysis if before registration
If you have any more questions about the new kidney transplant allocation guidelines, don’t hesitate to call us at 314-577-8867.