title: A comparative study of the traditional method, and a point-score system for allocation of deceased-donor kidneys: a national multicenter study in Mexico.
abstract: BACKGROUND
  The National Transplant Center in Mexico has ruled that deceased-donor kidney allocation is a function of each hospital's Internal Transplant Committee. The aim of this study was to compare and analyze results for of the traditional method and a point-score system in the allocation of deceased patient's kidneys.
  
  
  METHODS
  The 12 major kidney transplant centers in the country having a deceased-donor program were invited to participate. Only 3 of them replied to the invitation during 2010. A point-score system was proposed to them, comprising blood group, waiting list time, HLA type, and donor and recipient ages. Once the final recipient was chosen, an explanation of reasons for the choice was requested. Thirty-eight transplants were presented. Kappa coefficient was used to measure degree of agreement in both allocation systems. Organs donated for transplantation came from patients between 4 and 54 years old, including 52% female, 52% O+ blood type, 31% A+, and 11% B+, 44% cranial-encephalic trauma, and 44% brain hemorrhage.
  
  
  RESULTS
  Global agreement was 52.6% (kappa = 0.343), and partial agreement was 76.3% (weighted kappa = 0.204), assigning more intensity to extreme values, but with a lower correlation index. A more intense agreement, without discriminating by hospital, was found for "A" category (blood group), followed by "B" category (waiting list time).
  
  
  CONCLUSIONS
  Taking into consideration the determining factors for long-term graft survival, it is indispensable to include criteria such as donor and recipient ages and HLA typife in the allocation process. This first draft of a point-score system in organ allocation included waiting list time, blood group, urgency related to vascular/peritoneal access for dialysis, clinical condition, donor/recipient age ratio, and HLA antigenic compatibility.
authors.affiliation: School of Medicine, Universidad Panamericana, Mexico City, Mexico. gcantu@up.edu.mx
authors.forename: G
authors.initials: G
authors.lastname: Cantú-Quintanilla
authors.forename: J
authors.initials: J
authors.lastname: Alberú
authors.forename: R
authors.initials: R
authors.lastname: Reyes-Acevedo
authors.forename: M
authors.initials: M
authors.lastname: Medeiros
authors.forename: M S
authors.initials: MS
authors.lastname: Villa
authors.forename: J M
authors.initials: JM
authors.lastname: Arreola
authors.forename: C
authors.initials: C
authors.lastname: Gracida
authors.forename: A
authors.initials: A
authors.lastname: Reyes-López
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004992:Ethics, Medical; D005260:Female; D006680:HLA Antigens / Q000378:metabolism; D006801:Humans; D020300:Intracranial Hemorrhages / Q000401:mortality; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008800:Mexico; D008875:Middle Aged; D015203:Reproducibility of Results; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods* / Q000592:standards
chemical_list: D006680:HLA Antigens