United Network for Organ Sharing: Organ Donation and Transplantation

Kidney Allocation Policy Development

Mission

The National Organ Transplant Act (NOTA) requires that the Organ Procurement and Transplantation Network (OPTN) develop medical criteria for equitable organ allocation. The allocation policy has always balanced considerations of justice and utility in organ allocation. Over time, the kidney allocation formula has become unbalanced because the utility component (HLA matching) has diminished in emphasis.

The OPTN/UNOS Kidney Transplantation Committee is charged with reviewing the current kidney allocation system and making recommendations for improvement of the system.

Background

At the start of this process in 2004, the Committee held public hearings to learn about the concerns of the transplant community and general public about the current system and identify areas for improvement. Since those initial hearings, the Committee has worked with the Scientific Registry for Transplant Recipients (SRTR) to simulate various allocation concepts.

Under consideration

New medical criteria for the utility component are being considered. On February 8, 2007, the Committee held a public forum for members of the transplant community and general public to vet the concepts under consideration. Specifically, the Committee wanted feedback on the concept of Life Years from Transplant (LYFT), which is the difference between a transplant candidate's estimated survival with a transplant minus their estimated survival on the waiting list without a transplant. LYFT is calculated based on several candidate-specific factors including age, diabetes status, BMI, albumin, degree of sensitization (PRA), and degree of HLA mismatch with a potential donor.

LYFT has the potential to result in thousands more years of life for patients receiving kidney transplants. The committee is also considering a modification to the medical criteria for justice by modifying a patient's LYFT score by time on dialysis. Additionally, the committee is considering a new method of matching donors and potential recipients as a way of achieving both utility and justice.

The Committee met on February 9, 2007, to discuss how to incorporate feedback from the public forum into the development of a policy proposal. Please note that a policy proposal has not been developed at this time.

What's next?

Once a proposal is developed, the Committee will continue to follow the OPTN/UNOS policy development process, which provides multiple opportunities for individuals and organizations to comment through meetings and written submission. The Committee also plans to hold a second public forum during the public comment period to obtain feedback after a proposal has been developed.

You can learn more about the concepts under consideration through the materials provided below. Please check this site frequently as new materials will be added as they become available.

Resources