Figure 812

The United Network for Organ Sharing (UNOS) patient waiting list. The UNOS patient waiting list is a computerized list of patients waiting to be matched with specific donor organs in the hope of receiving a transplantation. Patients on the waiting list are registered on the UNOS computer by UNOS member transplantation centers, programs, or organ procurement organizations. The UNOS Match System is an algorithm used to prioritize patients waiting for organs. The system eliminates potential recipients whose size or ABO type is incompatible with that of a donor and then ranks those remaining potential recipients according to a UNOS board-approved system. As indicated here, nearly 40,000 patients are awaiting kidney transplantation in the United States. (Adapted from the United Network for Organ Sharing [2]).

Transplantation as Treatment of End-Stage Renal Disease POINT SYSTEM FOR KIDNEY ALLOCATION

Time of waiting

The "time of waiting" begins when a patient is listed and meets the minimum established criteria on the United Network for Organ Sharing Patient Waiting List. One point will be assigned to the patient waiting for the longest period, with fractions of points being assigned proportionately to all other patients according to their relative time of waiting.

Quality of HLA mismatch

10 points if there are no A, B, or DR mismatches.

7 points if there are no B or DR mismatches.

5 points if there is one B or DR mismatch.

2 points if there is a total of two mismatches at the B and DR loci.

Panel reactive antibody

Patients will be assigned 4 points if they have a panel reactive antibody level of 80% or more.

Medical urgency

No points will be assigned to patients based on medical urgency for regional or national allocation of kidneys. Locally, the patient's physician has the authority to use medical judgment in assignment of points for medical urgency. When there is more than one local renal transplantation center, a cooperative medical decision is required before assignment of points for medical urgency.

Pediatric kidney transplantation candidates

4 points if the patient is under 11 years of age.

3 points if the patient is over 11 and under 18 years of age.

Point system for kidney allocation. Kidneys that cannot be allocated to a human leukocyte antigen (HLA)-matched patient are distributed locally to candidates who are ranked according to waiting time, with additional points for degrees of HLA mismatch and antibody sensitization. Pediatric patients, medically urgent cases, and previous donors (living related donors, and so on) also are given a point advantage.

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