Impact of the 1998 UK National Allocation Scheme for deceased heartbeating donor kidneys.
BACKGROUND
National and regional strategies for allocating deceased heartbeating (DHB) donor kidneys to patients awaiting transplant are of great importance and have major implications for patients and healthcare systems. We describe the rationale for the 1998 National Kidney Allocation Scheme (1998 NKAS) and its impact on renal transplantation in the United Kingdom over 5 years.


METHODS
The 1998 NKAS was based on three tiers of patients defined by human leukocyte antigen (HLA) mismatch. This involved national allocation of well-matched kidneys in tiers 1 and 2, with regional allocation for less well-matched patients in tier 3. Pediatric patients (younger than 18 years) and regional patients were prioritized in tiers 1 and 2, with a points score based on six factors determining the specific priority order for allocation.


RESULTS
The 1998 NKAS allocated approximately half the kidneys from DHB donors to the national transplant list and resulted in significantly improved HLA matching, more than doubling the proportion of transplants that were 000 HLA-A, -B, and -DR mismatched from 7% to 16% for adults. Pediatric patients achieved comparable levels of HLA matching to adult patients for the first time in the United Kingdom through improved access to adult donor organs. The scheme also benefited highly sensitized patients and improved equity with regard to patient blood group, rareness of HLA type, and HLA homozygosity.


CONCLUSIONS
The 1998 NKAS represented a significant advance for the allocation of DHB donor kidneys in the United Kingdom and, while not addressing inequities in access to transplant, it did largely achieve the principal goal of improving HLA matching.
Fuggle
Susan V
SV
NHS Blood and Transplant, Bristol, United Kingdom. susan.fuggle@nds.ox.ac.uk
Johnson
Rachel J
RJ
Bradley
J Andrew
JA
Rudge
Chris J
CJ
D000293:Adolescent; D000328:Adult; D002102:Cadaver; D002648:Child; D006680:HLA Antigens / Q000276:immunology; D015234:HLA-A Antigens / Q000276:immunology; D015235:HLA-B Antigens / Q000276:immunology; D006684:HLA-DR Antigens / Q000276:immunology; D006339:Heart Rate; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D007668:Kidney; D016030:Kidney Transplantation / Q000276:immunology*; D018579:Patient Selection; D040841:Resource Allocation / Q000706:statistics & numerical data*; D014019:Tissue Donors / Q000600:supply & distribution*; D006113:United Kingdom
D006680:HLA Antigens; D015234:HLA-A Antigens; D015235:HLA-B Antigens; D006684:HLA-DR Antigens