Darren E Stewart, Loren Gragert, Michal A Mankowski
{"title":"Optimizing kidney allocation: challenges and solutions.","authors":"Darren E Stewart, Loren Gragert, Michal A Mankowski","doi":"10.1097/MOT.0000000000001195","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose of review: </strong>With the kidney nonuse rate approaching 30%, one-fifth of kidneys placed out of sequence, and unsatisfactory long-term recipient outcomes, U.S. kidney allocation is at a crossroads. This review highlights recent studies and efforts geared toward improving the system.</p><p><strong>Recent findings: </strong>The Organ Procurement & Transplantation Network's kidney transplantation committee is tasked with migrating kidney allocation policy, currently based on 250 nautical mile circles, to a fully continuous, points-based system. Challenges in designing a system assured to improve, not worsen, placement efficiency have hampered progress. OPO and transplant center practice patterns have adapted to a rapidly changing donation landscape. Advances in transplant immunology, particularly involving molecular HLA typing methods, are opening doors for more precise donor-recipient matching that appear to hold promise for improved long-term outcomes.</p><p><strong>Summary: </strong>The largely one-size-fits-all kidney allocation system is in desperate need of an overhaul. The continuous distribution paradigm is flexible enough to accommodate bold, new ideas for addressing major pain points in an equitable way. The OPTN should use policy variances to conduct time-limited, controlled experiments with various continuous distribution policies and build upon what works. Advances in transplant immunology, such as eplet matching, should increasingly be incorporated into kidney offer decision-making and, eventually, the allocation algorithm.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":"30 2","pages":"61-73"},"PeriodicalIF":1.8000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Current Opinion in Organ Transplantation","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/MOT.0000000000001195","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/27 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"TRANSPLANTATION","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose of review: With the kidney nonuse rate approaching 30%, one-fifth of kidneys placed out of sequence, and unsatisfactory long-term recipient outcomes, U.S. kidney allocation is at a crossroads. This review highlights recent studies and efforts geared toward improving the system.
Recent findings: The Organ Procurement & Transplantation Network's kidney transplantation committee is tasked with migrating kidney allocation policy, currently based on 250 nautical mile circles, to a fully continuous, points-based system. Challenges in designing a system assured to improve, not worsen, placement efficiency have hampered progress. OPO and transplant center practice patterns have adapted to a rapidly changing donation landscape. Advances in transplant immunology, particularly involving molecular HLA typing methods, are opening doors for more precise donor-recipient matching that appear to hold promise for improved long-term outcomes.
Summary: The largely one-size-fits-all kidney allocation system is in desperate need of an overhaul. The continuous distribution paradigm is flexible enough to accommodate bold, new ideas for addressing major pain points in an equitable way. The OPTN should use policy variances to conduct time-limited, controlled experiments with various continuous distribution policies and build upon what works. Advances in transplant immunology, such as eplet matching, should increasingly be incorporated into kidney offer decision-making and, eventually, the allocation algorithm.
期刊介绍:
Current Opinion in Organ Transplantation is an indispensable resource featuring key, up-to-date and important advances in the field from around the world. Led by renowned guest editors for each section, every bimonthly issue of Current Opinion in Organ Transplantation delivers a fresh insight into topics such as stem cell transplantation, immunosuppression, tolerance induction and organ preservation and procurement. With 18 sections in total, the journal provides a convenient and thorough review of the field and will be of interest to researchers, surgeons and other healthcare professionals alike.