Review of the Uruguayan Kidney Allocation System: the solution to a complex problem, preliminary data.
The National Kidney Transplant Program with cadaveric donors is based on centralized and unique waitlist, serum bank, and allocation criteria, approved by Instituto Nacional de Donación y Trasplante (INDT) in agreement with clinical teams. The median donor rates over last 3 years is 20 per million population and the median number of waitlist candidates is 450. The increased number of waiting list patients and the rapid aging of our populations demanded strategies for donor acceptance, candidate assignment, and analysis of more efficient and equitable allocation models. The objectives of the new national allocation system were to improve posttransplant patient and graft survivals, allow equal access to transplantation, and reduce waitlist times. The objective of this study was to analyze variables in our current allocation system and to create a mathematical/simulation model to evaluate a new allocation system. We compared candidates and transplanted patients for gender, age, ABO blood group, human leukocyte agents (HLA), percentage of reactive antibodies (PRA), and waiting list and dialysis times. Only 2 factors showed differences: highly sensitized and patients >65 years old (Bernoulli test). An agreement between INDT and Engineering Faculty yielded a major field of study. During 2008 the data analysis and model building began. The waiting list data of the last decade of donors and transplants were processed to develop a virtual model. We used inputs of candidates and donors, with outputs and structure of the simulation system to evaluate the proposed changes. Currently, the INDT and the Mathematics and Statistics Institute are working to develop a simulation model, that is able to analyze our new national allocation system.
Bengochea
M
M
Instituto Nacional de Donación y Trasplante, University of the Republic, Ministry of Public Health Montevideo, Uruguay. subdirindt@hc.edu.uy
Alvarez
I
I
Toledo
R
R
Carretto
E
E
Forteza
D
D
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007668:Kidney; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D040841:Resource Allocation / Q000458:organization & administration; D009927:Tissue and Organ Procurement / Q000458:organization & administration* / Q000706:statistics & numerical data; D014583:Uruguay; D014850:Waiting Lists