The development of new allocation policy for deceased donor kidneys.
The current system of kidney allocation in the United States has been undergoing review by the Organ Procurement and Transplantation Network. The Organ Procurement and Transplantation Network kidney committee is nearing the release of a draft proposal for sweeping changes in kidney allocation. The involvement of the renal community is critical to the successful development and implementation of these new policies. This review describes ethical issues related to allocation of scarce resources such as kidneys, the current US kidney allocation system and problems associated with it, as well as the development of a new model for kidney allocation. The new paradigm involves the application of 'life years from transplant'--an approach that compares predicted survival of a recipient after transplant versus remaining on dialysis, adjusted for multiple factors such as cause of renal failure, age and co-morbid conditions. Alternate systems as well as criticism of the current proposals are presented. The use of life years from transplant would increase allocation of kidneys to patients more likely to benefit from transplantation, resulting in many thousands of additional life-years saved. Such a scheme would also tend to assign these kidneys to younger patients, which has generated controversy.