Changing organ allocation policy for kidney transplantation in the United States

Abstract

The new kidney allocation scheme (KAS) in effect since December 4(th) 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.

Crossmatching in Renal Transplantation by Non-Immunologists for Non-Immunologists

“…Further testing to negate IgM and auto-antibodies has been suggested for the given case. In some patients with complex immunology, a careful and judicious use of a battery of immunology tests is of utmost importance to do a safe transplant and to avoid exclusion of a good donor [24].…”

Selection of Patients for Initial Clinical Trials of Solid Organ Xenotransplantation

“…However, UNOS implemented a new kidney allocation system (KAS), which likely has significantly changed kidney allocation, with many more patients with a cPRA of 98–100% receiving an acceptable donor kidney. 18,19 …”

Cultural Challenges in the Care of Refugees with End-Stage Renal Disease: What Western Nephrologists Should Know

“…One obstacle that may delay RTX to these patients is that in countries that consider vintage on dialysis in transplantation listing [17] , getting adequate documentation on the date of onset of ESRD from the country of origin, especially those shattered by war, may be a challenge. Similarly, in countries transplanting organs only to blood relatives, proving kinship between a refugee ESRD patients and a potential donor may be impossible.…”