Retrieval and allocation of organs for transplantation: the Michigan experience

The Organ Procurement Agency of Michigan (OPAM) is now in its twenty-third year of service to the transplant community in Michigan. From a beginning with one coordinator in 1971, it now employs 53 individuals, including 8 laboratory technologists for its own on-site histocompatibility laboratory, a dozen procurement coordinators stationed throughout the state, 6 organ placement coordinators in the main office, 6 screening coordinators who provide around-the-clock coverage at the office, a tissue recovery section, as well as additional finance, education, and administrative support staff. This chapter outlines the history and growth in organ recoveries of the organization. More importantly, the chapter also analyzes the Michigan experience regarding racial distribution of kidneys. While African-Americans comprise 14% of the general population of the state, they comprise 40% of the waiting kidney recipients and only 26% of the actual recipients. Depending upon blood type, average waiting time for a kidney for African-Americans can be up to 4 months longer than for Whites. The analysis attributes this variance primarily to the allocation methodology for kidney distribution, which is largely driven by antigen matching and secondarily to the generally greater frequency and higher degree of blood sensitization among African-Americans, which causes a substantially higher frequency of positive-crossmatch results between potential donor and recipient. The authors conclude that changes in the present allocation system could be made to achieve greater equity for African-American patients, without removing the advantages inherent in transplanting kidneys with closely matched antigens.