There are nearly 100,000 patients on the transplant waiting list for a deceased donor kidney transplant in the United States, including more than 600 here at the University of Chicago Medicine. But each year only about 11,000 people receive transplants from a deceased donor. An additional 5700 individuals receive the gift of life from a living donor.
Deceased donor kidneys are a scarce resource, and the rules for allocating them to patients are fraught with ethical questions. For the past eight years, the United Network for Organ Sharing (UNOS), the non-profit organization that manages the organ transplant system with the United States government, has been trying to revise its system for allocating kidneys from deceased donors to improve efficiency fairly.
In June of 2013, they approved significant revisions to the allocation policy, intended to increase access for all groups of candidates while improving success rates for those receive transplants. The new rules are expected to go into effect mid-2014.
Yolanda Becker, MD, is the director of the kidney and pancreas program at the University of Chicago Medicine and serves on the board of directors for UNOS. I spoke to her recently about the changes to the allocation system, why they have been so controversial and how she thinks the new system will improve access for more patients in need of a kidney transplant.
Why was there a need to overhaul the current allocation system?
The whole reason was that there were disparities with minorities and certain geographic areas. The new allocation system does not necessarily tackle geographic disparities, but really tried to diminish ethnic and minority disparities in access to transplant. Allocation is based upon a complex point system, and in the current system, the points started adding up when somebody got to the waiting list. So you could imagine, if you are a very savvy medical consumer, then you get to the waiting list a lot faster than those people who have less access to healthcare This was a clear disadvantage to some individuals.
How is the new system designed to fix this?
We basically reinvented the wheel. The new system gives the patient points based upon when they start dialysis. For instance, someone who has been on dialysis for 5 years comes to our center for evaluation for kidney transplant. In the old world he starts from point 0. In the new world he has 5 years, or five points, of waiting because he’s been on dialysis for 5 years. Continue Reading »