A new allocation plan for renal transplantation
| Autor: | Richard J. Rohrer, Helen Mah, Edgar L. Milford, Jonathan Himmelfarb, Laurine Bow, Francis L. Delmonico, William E. Harmon, George S. Lipkowitz, Jane Goguen, Shauneen Valliere, M. I. Lorber |
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| Rok vydání: | 1999 |
| Předmět: |
United Network for Organ Sharing
Waiting time Adult Pediatrics medicine.medical_specialty Time Factors Tissue and Organ Procurement Adolescent Waiting Lists Population Kidney New England Cadaver Medicine Humans education Child Transplantation education.field_of_study Health Care Rationing Geography business.industry Histocompatibility Testing Organ Preservation Kidney Transplantation Cadaver donor Tissue Donors United States Renal allograft Surgery Linear correlation business Algorithms |
| Zdroj: | Transplantation. 67(2) |
| ISSN: | 0041-1337 |
| Popis: | Background. A novel plan of renal allograft allocation has been conducted by United Network for Organ Sharing Region 1 transplant centers since September 3, 1996, based upon HLA matching, time waiting, and population distance points. The objectives of this plan were to achieve a balance between increasing the opportunity of renal transplantation for those patients listed with long waiting times and promoting local organ donor availability. Methods. A single list of candidates was formulated for each cadaver donor, assigning a maximum of 8 points for time waiting, a maximum of 8 points for population distance from the donor hospital, and HLA points based upon the degree of B/DR mismatch. Additional points were awarded to a cross-match-negative patient with a panel-reactive antibody of >80%, and to pediatric patients. Results. The total number of kidneys transplanted to patients who had waited >3 years was 100 (46%), and to patients who had waited >2.5-3 years was 29 (13%). However, the total number of kidneys transplanted to patients with the maximum population distance points was only 72 (33%). Thus, although the plan achieved a favorable distribution of kidneys to patients with longer waiting times (nearly 60%), the other, equally important objective of promoting local donor availability was not initially accomplished. Moreover, minor HLA B/DR differences between the donor and the recipient (i.e., not phenotypically matched) were unexpectedly consequential in determining allocation. As a result of these observations, the following adjustments were made in the plan (as of December 3, 1997): a maximum of 10 points for population distance, a maximum of 8 points for time waiting (both by a linear correlation), and the retention of HLA points for 0 B/DR mismatch only. After these interval changes, the percentage of patients receiving a kidney with some population distance points increased from 85% to 96%. Conclusions. We have shown that a heterogeneous region of multiple transplant centers can devise (and modify) an innovative and balanced plan that provides an equitable system of allocation for an everincreasing number of patients. |
| Databáze: | OpenAIRE |
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