Defiance of Occam ’s Razor: Recent Changes in US Kidney Allocation and Impact on Efficiency and Marginal Kidney Outcomes

AbstractPurpose of ReviewRecent changes in US kidney allocation policy have created concerns regarding negative effects on allocation efficiency secondary to increasing complexity. The purpose of this review is to examine available data on the impact of circle-based allocation policies on kidney transplant outcomes and lessons learned following similar changes in liver allocation.Recent FindingsChanges to circle-based allocation policy have exponentially increased organ offer burden and negatively influenced cold ischemia times (CIT) and travel logistics. For liver allocation, which proceeded kidney allocation changes, these negative consequences were in conjunction with no significant improvements in regional variation, which was the primary intent of policy changes. Kidney allocation changes have increased CIT without corresponding increases in travel distances, suggesting worsening inefficiencies attributed to increased complexity of interactions between multiple transplant centers and organ procurement organizations. Prolonged CIT is an important predictor of delayed graft function, non-function, and graft loss, particularly with “marginal” donor kidneys.SummaryChanges in organ allocation to donor hospital-based circles have increased offer burden and kidney non-utilization rates while unmasking and exacerbating allocation and logistical inefficiencies.
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research