New Kidney Allocation Policy Goes into Effect Dec. 4

More than 16,000 men, women and children in the United States get successful kidney transplants each year.
United Network for Organ Sharing (UNOS)—a nonprofit that runs the nation’s transplant system under contract with the federal government—is responsible for matching kidneys and other organs from deceased donors with patients on the waiting list. Many factors go into the matching process. They include blood type, body size, tissue typing match, distance from the donor hospital to the transplant candidate’s hospital, and the time a candidate has spent waiting.

Transplant and donation professionals, along with patient and donor family representatives, volunteer on committees and a board of directors to constantly look for ways to improve how we share organs and increase patient safety.
We have been matching kidneys with patients pretty much the same way since 1988. But the current system doesn’t take into account the biologic needs of people with immune system sensitivity very well.  Nor does it maximize the use of kidneys.

An improved kidney matching system that addresses these issues will take effect on Dec. 4. It will help more people have longer function with their transplanted kidneys. It will also shorten the wait for some groups of people who often wait a very long time because they are hard to match with most kidneys.

Transplant candidates already on the waiting list will not lose credit for any time they already spent waiting, which is a major factor in kidney allocation. For those patients who began dialysis before they were listed for a kidney transplant, their waiting time will be backdated to the day they first had dialysis.

Each kidney transplant candidate will receive a score estimating how long he or she will need a kidney transplant relative to the others listed for a kidney transplant. Each kidney will also receive a score.  It predicts how long the kidney is likely to function compared to other kidneys. The 20 percent of kidneys that have the longest expected function will be offered first to the 20 percent of candidates who will need a kidney for the longest time. This will reduce the need for patients to be relisted for a second or third kidney.  The majority of kidneys—the other 80 percent—will be matched much as they are now.
Kidneys that may last a shorter time will be more readily available for people who have a hard time remaining on dialysis. The 15 percent of kidneys expected to function the shortest amount of time will be offered first to a wider area of the country than other kidneys in order to find a suitable patient as quickly as possible.
UNOS provides a series of patient brochures called “Talking about Transplantation.” You can find a brochure that explains the new kidney allocation process at

If you’ve been diagnosed with kidney disease, you should talk to your physician about your treatment options, including whether or not you should be evaluated for kidney transplantation. It is best if patients are evaluated for transplant before they reach the latest stages of kidney failure. Visit for a list of transplant centers by state.

Your transplant team can discuss the best options for you based on your score and the types of kidneys that would best match your need.  

Richard Formica, M.D. is the chair of the OPTN/UNOS Kidney Transplantation Committee. He is director of Transplant Nephrology at Yale-New Haven Hospital and an associate professor of medicine and surgery at Yale School of Medicine.

Posted: | Author: Richard Formica, M.D.

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