There are 96,307 people waiting for kidney transplants in the United States (United Network for Organ Sharing Kidney (UNOS), 2018). There is an imbalance in the kidney transplant system, with an increasing rate of individuals with end stage renal disease (ESRD) placed on the waitlist and no corresponding increase in donors. The UNOS Transplant Allocation Policy identifies the organ viability criteria and the allocation of kidneys upon procurement (UNOS, 2018). The objective of this Capstone Project is to propose policy recommendations to increase access to kidneys for transplantation. The project included a comprehensive review of the peer-reviewed literature, current policies and guidelines, a comprehensive interview with a key opinion leader, with informed policy recommendations. The findings indicate a high volume of discarded viable kidneys associated with risk aversion by surgeons to avoid poor evaluations from the Scientific Registry of Transplant Recipients (Stewart et al, 2017). Analysis of these results supports three policy recommendations for UNOS and the Organ Procurement and Transplantation Network (OPTNS). These include (1) amending the criteria to prohibit rejecting and discarding kidneys based on the possibility that the patient is likely to live long enough to receive a higher-quality kidney; (2) drafting provisions to penalize hospitals that discard kidneys without offering them back to their local Organ Procurement Organization (OPO) for other eligible patients and (3) revising provisions regarding one-year post-transplant survival rates to encourage more transplants for patients with ESRD and to increase access in donor service areas to reduce access disparities. Implementing and enforcing these changes can increase access to viable organs and to reduce the time and mortality for patients on the waiting list.
Lopez Solano, MPHc, Lorena P. and Romney, RN, MS, JDC, MPH, Martha C., "Improving Access in Kidney Transplant Allocation in the United States" (2018). Master of Public Health Capstone Presentations. Presentation 277.