Greater complexity and monitoring of the new Kidney Allocation System: Implications and unintended consequences of concentric circle kidney allocation on network complexity

Am J Transplant. 2021 Jun;21(6):2007-2013. doi: 10.1111/ajt.16441. Epub 2021 Jan 2.


The deceased donor kidney allocation system in the United States has undergone several rounds of iterative changes, but these changes were not explicitly designed to address the geographic variation in access to transplantation. The new allocation system, expected to start in December 2020, changes the definition of "local allocation" from the Donation Service Area to 250 nautical mile circles originating from the donor hospital. While other solid organs have adopted a similar approach, the larger number of both kidney transplant centers and transplant candidates is likely to have different consequences. Here, we discuss the incredible increase in complexity in allocation, discuss some of the likely intended and unintended consequences, and propose metrics to monitor the new system.

Keywords: United Network for Organ Sharing (UNOS); clinical research/practice; donors and donation: deceased; ethics and public policy; kidney transplantation/nephrology; organ acceptance; organ procurement; organ procurement and allocation.

MeSH terms

  • Humans
  • Kidney
  • Kidney Transplantation*
  • Tissue Donors
  • Tissue and Organ Procurement*
  • United States
  • Waiting Lists