John Friedewald is the OPTN/UNOS Kidney Transplantation Committee chair.
For most of human history, kidney failure was a death sentence for those who encountered it. Today dialysis is effective in supporting people with kidney failure, but it too comes with limitations and potential complications. Kidney transplantation offers many the most effective long-term improvement in length and quality of life.
The way kidneys from deceased donors are matched to patients in the United States has not changed fundamentally in the last 25 years. The existing policy has facilitated more than 200,000 transplants over the years and has many well-designed features. Yet there are specific opportunities for improvement.
The Organ Procurement and Transplantation Network (OPTN), managed under federal contract by the non-profit United Network for Organ Sharing (UNOS), matches deceased donor kidneys with transplant candidates nationwide. The OPTN is seeking public comment on a proposal to make needed improvements to kidney allocation policy.
The proposal is the result of eight years of study and discussion among transplant professionals and patient advocates. Under the proposal, the 20 percent of kidneys likely to have the longest function would be offered first (but not exclusively) to the 20 percent of candidates estimated to have the longest need for a donated kidney. Fewer recipients should need a repeat transplant, thus making more kidneys available for first-time recipients.
Some available kidneys go unused, thus benefiting no one. The proposed policy would offer some kidneys with shorter estimated function on a wider geographic basis, most often for people who face a limited life expectancy on dialysis and who may die waiting for a transplant under the current system.
Certain groups of candidates are hard to match under the current system, perhaps because of a rare blood type or because their immune system is likely to reject many of the kidneys they are offered. The proposal should allow them appropriate access to matching organs.
Some ask whether these changes make the system more equitable or "fair." We believe so. Organ allocation is "fair" to all only when everyone has a transplant opportunity. Unfortunately that is not true today, and with more than 90,000 people listed for a kidney, it is not likely to happen soon. We can, however, be more effective stewards of the limited supply of donated kidneys.
We can better ensure recipients get the longest possible benefit from a transplant, and allow more people to get transplants with the supply we have. We can also address the needs of groups of candidates the current system does not serve as well as others.
Some question whether older candidates will still have a transplant opportunity. We have carefully weighed the proposal to maintain transplant access for all groups of candidates. We have repeatedly adjusted it, based on data and expert opinion, to ensure that "additional benefit" does not compromise other measures of equity. Most candidates should not see major changes in how they are prioritized for transplantation. Some will have more benefit, and the net effect should be more transplant opportunities for all.
The true solution to the organ shortage is to have enough donor organs available to help all in need. We urge the public to help through their commitment to organ donation. In the meantime, we will do our utmost to ensure that donated organs are used in the best way possible.
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