Equity in kidney transplant allocation - North American perspective

Area of Science:

• Nephrology
• Transplantation Medicine
• Health Policy

Background:

• The Organ Procurement and Transplantation Network (OPTN) implemented a new kidney allocation policy in 2014.
• This policy aimed to address disparities and inequities in kidney transplant access.

Purpose of the Study:

• Review the impact of the 2014 kidney allocation policy on transplant equity.
• Assess future directions to achieve equity in kidney transplantation.

Main Methods:

• Review of policy changes and their effects on kidney allocation.
• Analysis of data related to organ utilization and discard rates.
• Identification of areas requiring further investigation for improving equity.

Main Results:

• The 2014 policy reduced organ/recipient longevity mismatches and prioritized highly sensitized patients.
• Waitlist time was backdated to the start of dialysis.
• However, the policy did not improve the utilization of high-kidney donor profile index kidneys or decrease kidney discard rates.

Conclusions:

• While the supply-to-demand gap has decreased, significant inequities persist.
• Further research is needed on geographic disparities, referral barriers, and transplant center practices.
• Addressing pre-waitlist factors is crucial for achieving equitable kidney transplantation.