Computer analysis of cadaver kidney allocation procedures.

Data of 32,000 donors were utilized for a computer simulation to analyze the effect of selection parameters on the outcome of kidney transplants. If the HLA match grade is considered for organ allocation, the overall 1-year graft survival rate is up to 7% higher for first cadaver transplants and up to 12% higher for second transplants than if HLA matching is disregarded. This solely success-oriented organ allocation method, however, leads to prolonged waiting times for patients with rare HLA phenotypes. We developed a selection procedure that yields results near the theoretical optimum: 95% of all patients can be transplanted with 0-2 HLA-A, -B, -DR antigen mismatches, the average waiting time decreases to 20 months, and no patient needs to wait longer for a transplant than 6 years. The overall graft survival rate is only 0.4% lower than the rate obtainable with strictly HLA-oriented allocation. The method prevents "poorly matchable" patients from accumulating on the waiting list. Additionally, the unfavorable race ratio in the North American recipient pool can be largely normalized.