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The Impact of the Donor Card Holder Prioritization Program on Kidney Allocation in Israel
Eytan Mor1,2,3, Meitar Bloom3, Ronen Ghinea1,2,3
1Renal Transplant Center, Sheba Medical Center, Tel Hashomer, Israel.
Insights
Giving extra points for donor cards (DCH) in Israel significantly reduced kidney transplant waiting times for DCH. However, the study suggests re-evaluating point allocation for fairness, especially considering dialysis duration.
Area of Science:
- Nephrology
- Transplantation Immunology
- Public Health Policy
Background:
- In Israel, a priority program grants extra points to waitlisted kidney transplant candidates who are donor card holders (DCH).
- This policy aims to incentivize organ donation and potentially expedite deceased donor kidney allocation.
- The impact of these additional points on actual transplant outcomes and allocation fairness was not fully understood.
Purpose of the Study:
- To assess the effect of additional points awarded to donor card holders (DCH) on deceased donor kidney allocation.
- To analyze the impact of DCH status and associated extra points on kidney transplant waiting times.
- To evaluate the fairness and efficiency of the current allocation system based on DCH scoring.
Main Methods:
- A retrospective study analyzed deceased donor kidney transplantations in patients over 18 years old from January 2016 to December 2019.
- Data were sourced from the National HLA Tissue Laboratory registry at Sheba Medical Center.
- Patients were categorized by donor card status and associated points (none, relative signed, patient signed, relative donated), and waiting times were compared.
Main Results:
- Out of 444 kidney transplants, 281 (63%) recipients were DCH. DCH with extra points waited an average of 68.0 months, compared to 94.6 months for non-DCH (P < 0.001).
- Multivariable analysis confirmed that donor card signers experienced shorter waiting times.
- Without the extra points, 32.6% of recipients would have missed organs allocated to higher-scored candidates, with allocation changes observed across different point increments.
Conclusions:
- Additional points for donor card holders (DCH) demonstrably improved kidney allocation and reduced waiting times for eligible recipients.
- The current scoring system, heavily reliant on the social criterion of DCH status, may warrant adjustments.
- Recommendations include reducing the weight of DCH scores and increasing emphasis on factors like dialysis duration to enhance allocation fairness.
Background:
Since 2014, as part of a priority program within the Israeli Transplant Law, additional points were given to waitlisted candidates with donor cards. We assessed the impact on deceased donor kidney allocation.
Methods:
This study enrolled all patients older than 18 y who underwent deceased donor kidney transplantation (January 2016-December 2019). Data were obtained from the National HLA Tissue Laboratory registry at the Sheba Medical Center. Patients were grouped by donor card status (ADI group) (not signed, 0 points; relative signed, 0.1 points; patient signed, 2 points; and relative donated, 9 points). The primary outcome was waiting time until kidney transplantation with and without the additional score.
Results:
Four hundred forty-four patients underwent kidney transplantation during the study period: 281 (63%) were donor card holders (DCH) and 163 (37%) were not DCH. DCH with extra points waited 68.0 (±47.0) mo on average, compared with 94.6 (±47.3) mo for not DCH ( P < 0.001). Donor card signers had a shorter time until transplant in a multivariable model. Without extra points, 145 recipients (32.6%) would have missed organs allocated to higher-scored candidates. Allocation changes occurred in 1 patient because of an additional 0.1 points, in 103 candidates because of an additional 2 points, and in 41 candidates because of an additional 9 points.
Conclusions:
Additional DCH scores improved allocation and reduced waiting time for donor card signers and those with donating relatives. To enhance fairness, consideration should be given to reducing the score weight of this social criterion and raising scores for other factors, especially dialysis duration.
