PMID- 23726560
OWN - NLM
STAT- MEDLINE
DCOM- 20131230
LR  - 20130603
IS  - 1873-2623 (Electronic)
IS  - 0041-1345 (Linking)
VI  - 45
IP  - 4
DP  - 2013 May
TI  - A new kidney allocation policy in Chile: computer-based simulations.
PG  - 1313-5
LID - S0041-1345(13)00043-2 [pii]
LID - 10.1016/j.transproceed.2013.01.012 [doi]
AB  - INTRODUCTION: Kidney allocation should reach a balance between equity and 
      efficiency. In Chile kidneys are allocated based on ABO matching, first to 
      medical priorities and then according to a point scheme considering human 
      leukocyte antigen (HLA) match (60%), waiting list time (20%), and panel-reactive 
      antibodies (PRA; 20%); pediatric recipients receive extra points. A new policy 
      maintains ABO matching and medical priorities as the first step, but incorporates 
      other successive steps: previous living donors donors, 0 mismatch, pediatric 
      recipients, and finally all other recipients according to a point scheme 
      incorporating recipient age, HLA match, PRA, and time on waiting list with 
      similar proportions. We compared the resulting transplantations using the new 
      versus the older allocation policy. METHODS: We analyzed computer-generated 
      simulations using actual patients (N = 1176) on the Chilean waiting list in 2011 
      with the 300 donors over the previous 3 years. RESULTS: The new policy a 
      significantly decreased recipient age from 43 +/- 0.3 years to 41 +/- 0.3 and 
      increased the number of 0-mismatched transplantations from 3% to 4%. The mean HLA 
      mismatch increased from 2.8 +/- 0.1 to 3.6 +/- 0.1. Waiting time increased from a 
      mean of 38 +/- 1 months to 40 +/- 1 months, but patients remaining on the waiting 
      list had less waiting time with the new rule. CONCLUSIONS: With the proposed 
      changes younger patients are being privileged and the importance of compatibility 
      is diminished (except for 0-mismatched transplantations). The chance of a good 
      match is directly related to the size of the recipient pool, thus an allocation 
      policy that privileges HLA matching in a restricted recipient pool is especially 
      unfavorable for younger patients. Including age of the recipient as a continuum 
      can help to compensate for this lack of equity. Computer-generated simulations 
      can help discern which policies are best suited for each country based on their 
      local characteristics.
CI  - Copyright (c) 2013 Elsevier Inc. All rights reserved.
FAU - Dominguez, J
AU  - Dominguez J
AD  - Facultad de Medicina, Departamento de Urologia, Pontificia Universidad Catolica 
      de Chile, Santiago, Chile. javierdomi@hotmail.com
FAU - Harrison, R
AU  - Harrison R
FAU - Atal, R
AU  - Atal R
FAU - Munoz, F
AU  - Munoz F
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Transplant Proc
JT  - Transplantation proceedings
JID - 0243532
SB  - IM
MH  - Adult
MH  - Chile
MH  - *Computer Simulation
MH  - *Health Care Rationing
MH  - Histocompatibility Testing
MH  - Humans
MH  - *Kidney Transplantation
MH  - Waiting Lists
EDAT- 2013/06/04 06:00
MHDA- 2014/01/01 06:00
CRDT- 2013/06/04 06:00
PHST- 2012/12/16 00:00 [received]
PHST- 2013/01/15 00:00 [accepted]
PHST- 2013/06/04 06:00 [entrez]
PHST- 2013/06/04 06:00 [pubmed]
PHST- 2014/01/01 06:00 [medline]
AID - S0041-1345(13)00043-2 [pii]
AID - 10.1016/j.transproceed.2013.01.012 [doi]
PST - ppublish
SO  - Transplant Proc. 2013 May;45(4):1313-5. doi: 10.1016/j.transproceed.2013.01.012.