Global trends and challenges in deceased donor kidney allocation

Kidney Int. 2017 Jun;91(6):1287-1299. doi: 10.1016/j.kint.2016.09.054. Epub 2017 Mar 18.


Worldwide, the number of patients able to benefit from kidney transplantation is greatly restricted by the severe shortage of deceased donor organs. Allocation of this scarce resource is increasingly challenging and complex. Striking an acceptable balance between efficient use of (utility) and fair access to (equity) the limited supply of donated kidneys raises controversial but important debates at ethical, medical, and social levels. There is no international consensus on the recipient and donor factors that should be considered in the kidney allocation process. There is a general trend toward a reduction in the influence of human leukocyte antigen mismatch and an increase in the importance of other factors shown to affect posttransplant outcomes, such as cold ischemia, duration of dialysis, donor and recipient age, and comorbidity. Increased consideration of equity has led to improved access to transplantation for disadvantaged patient groups. There has been an overall improvement in the transparency and accountability of allocation policies. Novel and contentious approaches in kidney allocation include the use of survival prediction scores as a criterion for accessing the waiting list and at the point of organ offering with matching of predicted graft and recipient survival. This review compares the diverse international approaches to deceased donor kidney allocation and their evolution over the last decade.

Keywords: deceased donor; equity of access; kidney allocation; kidney transplantation; longevity matching; survival prediction.

Publication types

  • Review

MeSH terms

  • Diffusion of Innovation
  • Donor Selection / legislation & jurisprudence
  • Donor Selection / trends*
  • Global Health / legislation & jurisprudence
  • Global Health / trends*
  • Health Equity / trends
  • Health Policy / trends
  • Health Services Accessibility / legislation & jurisprudence
  • Health Services Accessibility / trends*
  • Healthcare Disparities / trends
  • Humans
  • Kidney Transplantation / adverse effects
  • Kidney Transplantation / legislation & jurisprudence
  • Kidney Transplantation / trends*
  • Policy Making
  • Time Factors
  • Tissue Donors / legislation & jurisprudence
  • Tissue Donors / supply & distribution*
  • Tissue and Organ Procurement / legislation & jurisprudence
  • Tissue and Organ Procurement / trends*