Allocation Of Abdominal Organs

Kidney Allocation

Kidneys are allocated on a local, regional, and national basis with the exception of mandatory sharing of six antigen matched kidneys. The allocation of cadaveric kidneys is made at the local level according to a point system. Patients on the local waiting list are offered kidneys in descending sequence with the patient with the highest number of points receiving the highest priority. A local area is defined by either the individual transplant center recipient list or a shared list of recipients within a defined procurement area which can be no larger than the OPO and service area designated by HCFA. The point system includes blood group, time of waiting, quality of antigen match, panel reactive antibody, and pediatric status. Medical urgency is not considered for kidney or pancreas allocation. A pay back system to the OPO of origin exists for six antigen match shared kidneys.

Pancreas/Kidney Allocation

Combined kidney/pancreas transplants are typically allocated according to the kidney allocation policies.

Liver Allocation

Organs are offered on a local, regional, and national basis. A point system similarly exists which includes blood group, time waiting, and degree of medical urgency. For every potential liver recipient, the acceptable donor size is determined and used as preliminary stratification.

Upon approval of the OPTN Board of Directors, a transplant center or an OPO may assign to each of the point systems' criteria, points other than the number of points set forth by OPTN policy. In 2000 UNOS adopted the Model for End-stage Liver Disease (MELD) system for predicting the prognosis of patients with endstage liver disease. The score relies on three laboratory parameters, bilirubin, pro-thrombin time (INR) and creatinine. A modification of the MELD system known as PELD has been adopted for allocating cadaveric livers to children. Both systems have been modified to take into account the patient with hepatocellular carcinoma, which can spread before bilirubin, prothrombin time and creatinine rise. Most agree that the new system is an improvement over the previous one, which depended heavily on waiting time, subjective prediction that death was likely within 7 days, and hospitalization in an intensive care unit.

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