title: Balancing organ quality, HLA-matching, and waiting times: impact of a pediatric priority allocation policy for deceased donor kidneys in Quebec.
abstract: Deceased donor kidney allocation policy must balance the desire for high-quality organs, good human leukocyte antigen (HLA) matching, and minimal waiting times. We describe a 10-fold reduction in waiting times and an improvement in nonimmunologic indices of organ quality for child recipients after a change in organ allocation policy in Quebec, Canada. The new policy gives first priority to children (<18 yr) irrespective of HLA matching or waiting time. HLA matching after the policy change was predictably much worse. This study highlights the trade-offs that must be considered both in setting allocation policy and in decisions for individual recipients. We also consider potential unintended negative effects of such a policy change.
authors.affiliation: Department of Pediatrics, Division of Nephrology (E-222), Montreal Children's Hospital, McGill University School of Medicine, Montreal, Canada.
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Crafter
authors.forename: Lorraine
authors.initials: L
authors.lastname: Bell
authors.forename: Bethany J
authors.initials: BJ
authors.lastname: Foster
mesh_terms: D000293:Adolescent; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D015276:Health Care Rationing; D006291:Health Policy; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D007668:Kidney / Q000503:physiopathology*; D011792:Quebec; D013997:Time Factors; D009927:Tissue and Organ Procurement; D014850:Waiting Lists