The kidney transplant waiting list
- Gabriel Danovitch, MD
Gabriel Danovitch, MD
- Distinguished Professor of Medicine
- University of California, Los Angeles
As of late 2010, a total of approximately 93,000 patients were registered on the kidney transplant waiting list at the United Network for Organ Sharing (UNOS) in the United States [1,2]. Registration on this list by individual transplant programs is required before a patient can be allocated a deceased donor organ. Over 30 percent of the list is registered in an "inactive" status, the significance of which will be discussed below.
This topic review will discuss the composition of and access to the kidney transplant waitlist, as well as the management of patients while they await allocation of a kidney. Additional information is available elsewhere [1,3-5] and on the UNOS website (www.UNOS.org).
The details of the allocation algorithm for deceased donor kidneys and issues related to the evaluation of the kidney transplant candidate, including the possible presence of coronary disease, are discussed separately. (See "Evaluation of the potential renal transplant recipient" and "Organ sharing in kidney transplantation".)
THE ACTIVE AND INACTIVE LIST
The kidney transplant waiting list in the United States had been expanding by 3000 to 4000 patients each year . However, the steady increase in the number of so-called active candidates has slowed, and, since 2001, this number has been stable at approximately 50,000 .
Current policy permits inactive candidates (also called "status 7") to accrue waiting time points; however, only active patients are allocated transplants. The purpose of this policy is to encourage transparency in listing so that the active transplant list truly reflects candidates who are prepared for imminent transplantation. Candidates are placed in an inactive status if an intercurrent condition develops that makes transplantation temporarily inadvisable (eg, during a hiatus after a treated malignancy while on the waiting list), although it is likely that some patients remain on the list despite conditions that are not reversible or while their initial work-up is being completed.
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- THE ACTIVE AND INACTIVE LIST
- Gender and blood group
- Renal diagnosis
- LISTING PRACTICES
- WAITING TIME
- Previously transplanted and presensitized patients
- DEATH ON THE WAITING LIST
- Expanded donor kidneys
- ACCESS TO THE WAITING LIST
- UNPREDICTABILITY OF ALLOCATION
- HEALTH MAINTENANCE
- Preventive health measures
- Cardiovascular testing
- Physical activity
- Obesity and weight loss
- INFORMATION FOR PATIENTS