Organ sharing in kidney transplantation
- William M Bennett, MD
William M Bennett, MD
- Medical Director
- Legacy Good Samaritan Transplant Services
- John Vella, MD, FACP, FRCP, FASN
John Vella, MD, FACP, FRCP, FASN
- Associate Professor of Medicine
- Tufts University School of Medicine
- Daniel C Brennan, MD, FACP
Daniel C Brennan, MD, FACP
- Editor-in-Chief — Nephrology
- Section Editor — Renal Transplantation
- Professor of Medicine
- Washington University School of Medicine
Organ sharing is a nationwide system by which deceased-donor kidneys are allocated to potential recipients. The deceased-donor kidney allocation policy of the United Network for Organ Sharing (UNOS)/Organ Procurement and Transplant Network (OPTN) was extensively revised and implemented December 4, 2014 and is presented in this topic review.
The evaluation of potential transplant recipients, including the optimal timing of referral, and issues related to the transplant waiting list, as well as live kidney paired donation, are discussed elsewhere. (See "Evaluation of the potential renal transplant recipient" and "The kidney transplant waiting list in the United States".)
NATIONAL DECEASED-DONOR KIDNEY ALLOCATION POLICY
Overview — A national kidney allocation policy was established in the United States in 1987 for the purpose of the equitable and utilitarian distribution of deceased-donor kidneys.
The policy was initially devised and agreed upon by the transplant programs that comprise the United Network for Organ Sharing (UNOS)/Organ Procurement and Transplant Network (OPTN).
A revised UNOS/OPTN policy was implemented in 2014 in order to increase the utilization of available kidneys, reduce regional variability in access to transplantation, and improve the outcomes for individual kidneys that are transplanted .
- http://optn.transplant.hrsa.gov/ (Accessed on April 01, 2015).
- http://optn.transplant.hrsa.gov/resources/allocationcalculators.asp?index=81 (Accessed on July 01, 2013).
- Takemoto S, Terasaki PI, Cecka JM, et al. Survival of nationally shared, HLA-matched kidney transplants from cadaveric donors. The UNOS Scientific Renal Transplant Registry. N Engl J Med 1992; 327:834.
- Braun WE. Every kidney counts. N Engl J Med 1992; 327:883.
- Stegall MD, Dean PG, McBride MA, et al. Survival of mandatorily shared cadaveric kidneys and their paybacks in the zero mismatch era. Transplantation 2002; 74:670.
- Norman DJ. The kidney transplant wait-list: allocation of patients to a limited supply of organs. Semin Dial 2005; 18:456.
- Takemoto SK, Terasaki PI, Gjertson DW, Cecka JM. Twelve years' experience with national sharing of HLA-matched cadaveric kidneys for transplantation. N Engl J Med 2000; 343:1078.
- US Transplant http://www.ustransplant.org (Accessed on February 10, 2010).
- Su X, Zenios SA, Chakkera H, et al. Diminishing significance of HLA matching in kidney transplantation. Am J Transplant 2004; 4:1501.
- Opelz G, Döhler B. Effect of human leukocyte antigen compatibility on kidney graft survival: comparative analysis of two decades. Transplantation 2007; 84:137.
- http://optn.transplant.hrsa.gov/media/1158/kas_report_02-2015.pdf (Accessed on March 12, 2015).