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Published on: March 15, 2024
The expanded criteria donor policy: an evaluation of program objectives and indirect ramifications
J D Schold1, R J Howard, M J Scicchitano
1Department of Medicine, University of Florida, Gainesville, Florida, USA. scholjd@medicine.ufl.edu
Summary
The 2002 expanded criteria donor (ECD) policy for kidneys improved access for elderly recipients but did not reduce wait times or cold ischemia. Selective center listing for ECDs is crucial for reducing wait times.
Area of Science:
- Nephrology and Transplant Surgery
- Organ Transplantation Policy
- Public Health and Healthcare Policy
Background:
- The 2002 expanded criteria donor (ECD) policy defined higher-risk deceased donor kidneys for transplantation.
- A comprehensive analysis of the ECD policy's impact on kidney allocation, waiting times, center listing patterns, and human leukocyte antigen (HLA) matching was lacking.
- Understanding these factors is crucial for optimizing kidney transplant outcomes.
Purpose of the Study:
- To comprehensively examine the impact of the 2002 ECD policy on kidney transplantation.
- To assess changes in recipient characteristics, waiting times, and cold ischemia time (CIT) post-policy implementation.
- To evaluate the influence of center listing patterns for ECD kidneys on recipient waiting times.
Main Methods:
- Analysis of a national database of transplant candidates from 1998 to 2004.
- Construction of statistical models to assess alterations in recipient characteristics and trends in waiting time and CIT.
- Evaluation of the correlation between the proportion of center candidate listings for ECDs and waiting times.
Main Results:
- Elderly recipients were more likely to receive ECD kidneys after policy implementation (OR=1.36, p<0.01).
- No significant association was found between policy inception and decreased CIT or pretransplant dialysis time, nor increased HLA mismatching.
- Centers with selective ECD listing (either <20% or >90% of candidates listed) showed varied outcomes, with only selective listing centers offering reduced waiting times.
Conclusions:
- The ECD policy has shown potential in achieving some objectives, such as increased access for elderly recipients.
- However, the policy's full potential to benefit all transplant candidates may not be realized without standardized and recommended ECD listing patterns.
- Optimizing center listing strategies is essential for maximizing the benefits of the ECD policy and reducing wait times for kidney transplantation.
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