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Review
. 2012 Dec;12(12):3191-212.
doi: 10.1111/j.1600-6143.2012.04259.x. Epub 2012 Nov 16.

Kidney, pancreas and liver allocation and distribution in the United States

J M Smith  1 , S W Biggins, D G Haselby, W R Kim, J Wedd, K Lamb, B Thompson, D L Segev, S Gustafson, R Kandaswamy, P G Stock, A J Matas, C J Samana, E F Sleeman, D Stewart, A Harper, E Edwards, J J Snyder, B L Kasiske, A K Israni
Affiliations
Review

Kidney, pancreas and liver allocation and distribution in the United States

J M Smith et al. Am J Transplant. 2012 Dec.

Abstract

Kidney transplant and liver transplant are the treatments of choice for patients with end-stage renal disease and end-stage liver disease, respectively. Pancreas transplant is most commonly performed along with kidney transplant in diabetic end-stage renal disease patients. Despite a steady increase in the numbers of kidney and liver transplants performed each year in the United States, a significant shortage of kidneys and livers available for transplant remains. Organ allocation is the process the Organ Procurement and Transplantation Network (OPTN) uses to determine which candidates are offered which deceased donor organs. OPTN is charged with ensuring the effectiveness, efficiency and equity of organ sharing in the national system of organ allocation. The policy has changed incrementally over time in efforts to optimize allocation to meet these often competing goals. This review describes the history, current status and future direction of policies regarding the allocation of abdominal organs for transplant, namely the kidney, liver and pancreas, in the United States.

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Conflict of interest statement

Disclosure

The authors of this manuscript have conflicts of interest to disclose as described by the American Journal of Transplantation: By virtue of employment at or affiliation with a transplant program or an organization with an interest in transplant program performance, any author of this manuscript could be perceived to have a conflict of interest. Beyond that, no author has any conflict of interest to disclose as described by the American Journal of Transplantation.

Figures

Figure 1
Figure 1. Organ Procurement and Transplantation Network’s allocation algorithm for kidney transplants for (A) standard criteria donors aged < 35 years; (B) standard criteria donors aged ≥ 35 years; (C) donation after cardiac death; (D) expanded criteria donors
CPRA = calculated panel-reactive antibodies; OPO = organ procurement organization; UNOS = United Network for Organ Sharing. This figure can be downloaded in color from www.srtr.org.
Figure 1
Figure 1. Organ Procurement and Transplantation Network’s allocation algorithm for kidney transplants for (A) standard criteria donors aged < 35 years; (B) standard criteria donors aged ≥ 35 years; (C) donation after cardiac death; (D) expanded criteria donors
CPRA = calculated panel-reactive antibodies; OPO = organ procurement organization; UNOS = United Network for Organ Sharing. This figure can be downloaded in color from www.srtr.org.
Figure 1
Figure 1. Organ Procurement and Transplantation Network’s allocation algorithm for kidney transplants for (A) standard criteria donors aged < 35 years; (B) standard criteria donors aged ≥ 35 years; (C) donation after cardiac death; (D) expanded criteria donors
CPRA = calculated panel-reactive antibodies; OPO = organ procurement organization; UNOS = United Network for Organ Sharing. This figure can be downloaded in color from www.srtr.org.
Figure 2
Figure 2
Regions of the Organ Procurement and Transplantation Network.
Figure 3
Figure 3. Pancreas allocation policy and the required sequence of kidney allocation
This figure can be downloaded in color from www.srtr.org.
Figure 4
Figure 4. Simultaneous kidney–pancreas allocation
This figure can be downloaded in color from www.srtr.org.
Figure 5
Figure 5. Pancreas-alone allocation, stratified by donor age and body mass index
This figure can be downloaded in color from www.srtr.org.
Figure 6
Figure 6. Combined kidney–pancreas/pancreas allocation for (A) donors aged ≤ 50 years with body mass index ≤ 30 kg/m2 and (B) combined kidney–pancreas/pancreas allocation for donors aged > 50 years or with body mass index > 30 kg/m2
This figure can be downloaded in color from www.srtr.org.
Figure 6
Figure 6. Combined kidney–pancreas/pancreas allocation for (A) donors aged ≤ 50 years with body mass index ≤ 30 kg/m2 and (B) combined kidney–pancreas/pancreas allocation for donors aged > 50 years or with body mass index > 30 kg/m2
This figure can be downloaded in color from www.srtr.org.
Figure 7
Figure 7. Allocation of livers from adult deceased donors
M/P, model for end-stage liver disease (MELD)/pediatric end-stage liver disease (PELD) score. This figure can be downloaded in color from www.srtr.org.
Figure 8
Figure 8. Allocation of livers from deceased donors aged 11–17 years
M/P, model for end-stage liver disease (MELD)/pediatric end-stage liver disease (PELD) score. This figure can be downloaded in color from www.srtr.org.
Figure 9
Figure 9. Allocation of livers from deceased donors aged 0–10 years
M/P, model for end-stage liver disease (MELD)/pediatric end-stage liver disease (PELD) score. This figure can be downloaded in color from www.srtr.org.
See this image and copyright information in PMC

References

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    1. Roberts JP, Wolfe RA, Bragg-Gresham JL, et al. Effect of changing the priority for HLA matching on the rates and outcomes of kidney transplantation in minority groups. N Engl J Med. 2004;350:545–551. - PubMed
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