A proposal for a new kidney allocation system

Lima, Bruno A.; Mendes, Miguel; Alves, Helena

http://hdl.handle.net/10400.18/2415

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Authors

Lima, Bruno A.

Mendes, Miguel

Alves, Helena

Abstract(s)

In light of the fact that deceased donor organs are a scarce resource, their distribution must be balanced in order to maximize utility and justice. It should take into account the relationship between supply and demand, hence seeking a balance between the higher net benefit of survival that can be provided by a particular organ and the transplant candidates’ waiting time (as well as the probability of being transplanted). We propose a colour system classification for kidney allocation that will allow clinicians to know the position of a particular patient in the access to kidney transplantation from a deceased donor at all times. This colour system would prioritize candidates by colour ranging from red to green. Red will be attributed to all clinically urgent candidates. Orange would be allocated to candidates with values of calculated PRA (cPRA) >85% or their time on dialyses being higher than the third quartile of wait listed patients’ time on dialysis to transplantation (i.e., how long it takes for 75% of wait-listed candidates to receive a transplant). Yellow would be given to candidates with cPRA >50% or time on dialysis being higher than the median of wait listed patients’ time on dialysis to transplantation (i.e., how long it takes for 50% of wait-listed candidates to receive a transplant). Green will be for all of the remaining candidates. Within each colour group, the candidates’ order will be determined taking into account the number of HLA compatibilities with the donor and, if a tie still persists, the decision is made by the time on dialysis. This proposition for a new allocation system of kidney transplantation would be more transparent than existing point systems and advantageous for both doctor and patient; with it, clinicians can explain to the patient in a more intuitive manner how far they are from being transplanted. Also the realization that patients classified as green will likely wait too long for an organ, can easily sway them toward the solution of transplantation with a living donor. The discussion about access to kidney transplantation with deceased donors never comes to a close and is always in need of improvements; therefore, it must be done clearly and systematically in order to enable the best decisions at any given moment.