Evaluation of the UNOS point system for kidney recipient selection.

1. The ultimate distribution of 479 consecutive cadaver donor kidneys in the Los Angeles area was examined to determine whether the distribution had been equitable. Half of the kidneys had been allocated by the UNOS point system (or slight modifications thereof) and half by the transplant centers according to their own criteria. 2. With respect to waiting time, the pool of 1,000 was composed of 14% patients who had waited more than 2 years. The UNOS point system forced the transplantation of more patients (27%) who had waited longer than 2 years than the nonpoint system (11%). 3. Although the waiting pool was composed of 28% waiting for retransplantation, the UNOS point system resulted in transplantation of 16% and the nonpoint system, 8%. 4. In the waiting pool, 16% of the patients had cytotoxic antibodies reactive to more than 80% of the panel, whereas 11% of the transplants by the UNOS point system were transplanted into highly sensitized patients and only 2% of the patients transplanted by the nonpoint system were highly sensitized. 5. In Los Angeles, where 11% of the population is Black, 10% of the kidneys transplanted were into Black patients. Since 18% of the waiting pool of patients were Black, some shortfall was noted. However, this can be attributed to the fact that only 7% of the donors were Black. The importance of increasing donation from the Black community is emphasized. 6. Because of the limited pool size of 1,000 patients only a small number of 0 B,DR transplants were achieved.(ABSTRACT TRUNCATED AT 250 WORDS)