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The United Network for Organ Sharing (UNOS) has proposed a new scheme for distributing deceased-donor kidneys among the 93,000 people currently waiting for a transplant. UNOS handles organ procurement and transplantation pursuant to a contract with the federal Department of Health and Human Services.

The current system has been fraught with inefficiencies and waste. Essentially administered on first-come, first-served basis, it is possible for younger patients to end up with older kidneys while older patients receive relatively young organs. As a result, young and healthy patients can outlive their transplant, while older patients might die even though their “new” kidney has several years of useful life left.

Lower-quality kidneys – often those from older donors or those with certain diseases – are offered to patients who have indicated a willingness to receive them. However, the patient is not required to accept such a kidney. About 2,600 kidneys were discarded last year, in part because they were not accepted by the potential recipient.

Under the proposed revisions, the candidates considered most likely to live the longest would receive the top 20% of viable kidneys. These candidates – likely to be young and otherwise healthy – would then be less likely to require subsequent transplantations. For the remainder of the candidates, the wait list would operate more or less like before, although a few tweaks would be made to the waiting time calculation and matching organs to difficult recipients.

Experts estimate that the proposed system could result in over 8,000 years of additional life from a single year of transplants. The proposal would also bring kidney allocation more in line with other deceased-donor organ procurement measures.

In 2011, nearly 5,000 people died waiting for a kidney transplant.

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