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Fig. 6.1. The number of patients on either dialysis therapy or living with a functional kidney transplant enrolled in the U.S. end-stage renal disease program in 2000 according to age.

kidney transplants enjoy outcomes that are superior to those receiving cadaveric transplants. Finally, improvements in the surgical technique using minimally invasive laparoscopic techniques have reduced the reluctance of persons willing to be a living donor.

Cadaveric organs are considered a scarce national resource. The judicious use of cadaveric organs to provide meaningful results for the greatest number of ill patients, without introducing racial bias or inhibiting access, are the underpinning principles of the methodology of cadaveric kidney allocation. Table 6.1 outlines some of the important determinants of the United Network for Organ Sharing (UNOS) cadaver kidney allocation system. The main determinants of kidney allocation include several recipient-specific variables (blood type, degree of sensitization to HLA antigens, pediatric, and donation status), donor variables (HLA matching, expanded criteria status), and accrued waiting time.

It is not a requisite that a patient with renal disease spend time on dialysis to be eligible for a transplant. In fact, outcomes of kidney transplantation are adversely

Fig. 6.2. The number of patients in the U.S. waiting for a kidney transplant, receiving a kidney transplant, and the number of cadaver organ donors per year.

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