Transplant Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK.
Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Hills Road, Cambridge, CB2 0QQ, UK.
Kidney Int. 2017 Jun;91(6):1287-1299. doi: 10.1016/j.kint.2016.09.054. Epub 2017 Mar 18.
Worldwide, the number of patients able to benefit from kidney transplantation is greatly restricted by the severe shortage of deceased donor organs. Allocation of this scarce resource is increasingly challenging and complex. Striking an acceptable balance between efficient use of (utility) and fair access to (equity) the limited supply of donated kidneys raises controversial but important debates at ethical, medical, and social levels. There is no international consensus on the recipient and donor factors that should be considered in the kidney allocation process. There is a general trend toward a reduction in the influence of human leukocyte antigen mismatch and an increase in the importance of other factors shown to affect posttransplant outcomes, such as cold ischemia, duration of dialysis, donor and recipient age, and comorbidity. Increased consideration of equity has led to improved access to transplantation for disadvantaged patient groups. There has been an overall improvement in the transparency and accountability of allocation policies. Novel and contentious approaches in kidney allocation include the use of survival prediction scores as a criterion for accessing the waiting list and at the point of organ offering with matching of predicted graft and recipient survival. This review compares the diverse international approaches to deceased donor kidney allocation and their evolution over the last decade.
在全球范围内，由于可供移植的死者供体器官严重短缺，能够受益于肾移植的患者数量受到极大限制。这种稀缺资源的分配越来越具有挑战性和复杂性。在有效利用（效用）和公平获得（公平）有限捐赠肾脏供应之间取得可接受的平衡，在伦理、医疗和社会层面引发了有争议但重要的辩论。对于在肾脏分配过程中应考虑哪些受者和供者因素，尚无国际共识。人们普遍倾向于减少人类白细胞抗原不匹配的影响，并增加其他影响移植后结果的因素的重要性，如冷缺血、透析时间、供者和受者年龄以及合并症。更多地考虑公平，使处境不利的患者群体能够更好地获得移植。分配政策的透明度和问责制得到了全面提高。肾脏分配中的新的和有争议的方法包括使用生存预测评分作为进入候补名单的标准，以及在器官提供时根据预测的移植物和受者生存率进行匹配。本文比较了不同国际的死者供体肾脏分配方法及其在过去十年中的演变。
