title: Impact of the expanded criteria donor allocation system on candidates for and recipients of expanded criteria donor kidneys.
abstract: BACKGROUND
  A national policy to allocate kidneys from expanded criteria donors (ECD) took effect October 31, 2002.
  
  
  METHODS
  To assess its impact, we analyzed data from the Scientific Registry of Transplant Recipients for ECD kidney candidates and recipients between November 1999 and October 2005.
  
  
  RESULTS
  The likelihood of being listed for ECD transplant, of receiving any transplant, and of receiving an ECD transplant were assessed using logistic regression models. As of October 31, 2005, 42.6% of candidates were listed with an ECD designation (range by donation service area [DSA], 1.9% to 94.9%). ECD-listed candidates were likely to be older, diabetic, and sensitized. By October 31, 2005, candidates listed for ECD as of November 1, 2002 were 41% more likely to receive any kidney transplant than those not ECD-listed. Among ECD-listed recipients, 30.1% received an ECD transplant and 69.9% a non-ECD transplant. Recipients more likely to receive an ECD transplant were significantly older and in DSAs where a high percentage of ECD transplants were performed and/or a low percentage of candidates were ECD-listed.
  
  
  CONCLUSIONS
  A large, regionally variable fraction of candidates are opting to receive ECD offers. Listing with an ECD designation increases the likelihood of transplantation in selected populations. Selective listing of ECD candidates is associated with a higher likelihood of receiving an ECD transplant.
authors.affiliation: Scientific Registry of Transplant Recipients, Division of Transplantation, Department of Surgery, University of Michigan Health System, Ann Arbor, MI 48109-0331, USA. rssung@umich.edu
authors.forename: Randall S
authors.initials: RS
authors.lastname: Sung
authors.forename: Mary K
authors.initials: MK
authors.lastname: Guidinger
authors.forename: Alan B
authors.initials: AB
authors.lastname: Leichtman
authors.forename: Craig
authors.initials: C
authors.lastname: Lake
authors.forename: Robert A
authors.initials: RA
authors.lastname: Metzger
authors.forename: Friedrich K
authors.initials: FK
authors.lastname: Port
authors.forename: Robert M
authors.initials: RM
authors.lastname: Merion
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D044469:Racial Groups; D012044:Regression Analysis; D040841:Resource Allocation / Q000379:methods*; D014019:Tissue Donors / Q000706:statistics & numerical data* / Q000600:supply & distribution*; D014850:Waiting Lists