The researchers found that a national optimized matching algorithm would result in more transplants (47.7 percent vs. 42.0 percent), better matches, and more grafts surviving at 5 years when compared with an extension of the currently used first-accept scheme to a national level. Highly sensitized patients, who are extremely difficult to match and typically wait almost 7 years for a deceased donor kidney, would benefit 6-fold from a national optimized algorithm (14.1 percent vs. 2.3 percent). Furthermore, to alleviate concerns that a national KPD program would require extensive travel to accommodate matches, the study shows how optimization would dramatically reduce the number of pairs required to travel (2.9 percent vs. 18.4 percent).
"Even if only 7 percent of patients awaiting kidney transplantation participated in an optimized national KPD program, the health care system could save as much as $750 million," the authors write. "Our simulations suggest that approximately 47 percent of incompatible pairs could be matched through an optimized national KPD program."
"Determining optimal allocation priorities and algorithms is absolutely crucial to the smart proliferation of KPD in the United States and the prevention of a haphazard system that diminishes the impact of this promising approach to the organ shortage," the researchers write. "We believe that KPD should be the preferred treatment for patients who have incompatibilities with their intended donors who wish to participate, as KPD is less expensive than desensitization and requires less immunosuppression."
Contact: Trent Stockton
JAMA and Archives Journals