Global trends and challenges in deceased donor kidney allocation.
Worldwide, the number of patients able to benefit from kidney transplantation is greatly restricted by the severe shortage of deceased donor organs. Allocation of this scarce resource is increasingly challenging and complex. Striking an acceptable balance between efficient use of (utility) and fair access to (equity) the limited supply of donated kidneys raises controversial but important debates at ethical, medical, and social levels. There is no international consensus on the recipient and donor factors that should be considered in the kidney allocation process. There is a general trend toward a reduction in the influence of human leukocyte antigen mismatch and an increase in the importance of other factors shown to affect posttransplant outcomes, such as cold ischemia, duration of dialysis, donor and recipient age, and comorbidity. Increased consideration of equity has led to improved access to transplantation for disadvantaged patient groups. There has been an overall improvement in the transparency and accountability of allocation policies. Novel and contentious approaches in kidney allocation include the use of survival prediction scores as a criterion for accessing the waiting list and at the point of organ offering with matching of predicted graft and recipient survival. This review compares the diverse international approaches to deceased donor kidney allocation and their evolution over the last decade.
Transplant Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK.
Diana A
DA
Wu
Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Hills Road, Cambridge, CB2 0QQ, UK.
Christopher J
CJ
Watson
Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Hills Road, Cambridge, CB2 0QQ, UK.
J Andrew
JA
Bradley
Organ Donation and Transplantation, NHS Blood and Transplant, Fox Den Road, Stoke Gifford, Bristol, BS34 8RR, UK.
Rachel J
RJ
Johnson
Transplant Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK.
John L
JL
Forsythe
Transplant Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK. Electronic address: gabriel.oniscu@ed.ac.uk.
Gabriel C
GC
Oniscu
D004059:Diffusion of Innovation; D046148:Donor Selection / Q000331:legislation & jurisprudence / Q000639:trends*; D014943:Global Health / Q000331:legislation & jurisprudence / Q000639:trends*; D000069576:Health Equity / Q000639:trends; D006291:Health Policy / Q000639:trends; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence / Q000639:trends*; D054625:Healthcare Disparities / Q000639:trends; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000331:legislation & jurisprudence / Q000639:trends*; D011050:Policy Making; D013997:Time Factors; D014019:Tissue Donors / Q000331:legislation & jurisprudence / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000331:legislation & jurisprudence / Q000639:trends*
deceased donor; equity of access; kidney allocation; kidney transplantation; longevity matching; survival prediction