A multifactorial system for equitable selection of cadaver kidney recipients

Abstract

During 1986, a total of 270 cadaver renal transplantations were performed at the University of Pittsburgh. Kidneys were allocated by a point system that awarded points to recipients for waiting time, antigen matching, antibody analyses, medical urgency, and logistic practicality. Kidneys were given to patients with the highest point totals in 98% of cases. To our knowledge, this is the first such multifactorial system for cadaver kidney allocation. Possibly it may be modified for extrarenal organs.

KIE: The University of Pittsburgh transplantation program has devised an objective, computerized, multifactorial system to allocate cadaver kidneys. Potential recipients are assigned points for waiting time, antigen matching, antibody analyses, medical urgency, and logistic practicality. No more than 5% of kidneys for which there is competition by American citizens may be given to nonresident aliens. During 1986, of 253 renal transplants matched by the system, 98% were performed on patients with the highest point scores. Whether similar selection techniques can be applied for liver and heart transplantation remains to be determined. At present, medical urgency and logistic requirements override all other factors.