UNOS/OPTN board revises kidney transplant policy to remove a bias against minority candidates on wait list.

Responding to critics who say the current organ allocation scheme in the US is unfair to minority patients on the waiting list for an organ transplant, the United Network for Organ Sharing (UNOS) Organ Procurement and Transplantation Network (OPTN) voted to reduce the importance of HLA (human leukocyte antigen) matching in deciding who gets an organ.

The change is expected to result in 200 additional kidney transplants annually for minority patients which would mean an 8% increase for African Americans, 7% for Asians and Hispanics, according to Win Williams, MD, chair of the UNOS/OPTN minority affairs committee and a transplant surgeon at Massachusetts General Hospital in Boston.

"We feel that issues of justice, fairness and equity are clearly addressed by this proposal," Williams said. "We hope that our emphasis on ensuring equity will boost the public's confidence in the transplant system. Greater public confidence can also raise people's willingness to become organ donors to help meet the needs of patients."

The policy addresses HLA matching, which measures the immune system compatibility between an organ donor and an individual patient. Traditionally, patients who have a higher level of HLA match with a potential donor have received higher priority to receive an organ.

Critics have charged that because HLA patterns are inherited, some minority patients are less well matched than Caucasian patients which in turn leads to longer waiting times for minority kidney transplant candidates. New studies reveal that HLA matching can be reduced somewhat without compromising graft function.

Under the old policy, 3 pairs of HLA antigens were compared between donor and the patient. Under the new policy, allocation priority will only be given for patients whose antigens match one or both donor antigens at one specific pair, know as the "DR locus."

The current national policy of giving priority to patients who have a "perfect" HLA match with a specific donor will continue.

"The importance of the UNOS decision to change the HLA matching policy is to affirm a goal of balancing equity with the utility of best outcome," Frank Delmonico, MD, told Transplant News. "The conclusion of the Wait List conference held last March was that minorities have been disadvantaged. The decision of the UNOS Board sends a clear message that allocation should be equitable for all patients who are on the wait list."

Delmonico, director of renal transplantation at Massachusetts General Hospital in Boston, chaired a meeting of 100 invited experts held last March that addressed the crisis developing because of the ever-growing waiting list for organs.

The consensus of the group at that time was that the B locus mismatches should be eliminated from the sharing algorithm and allocation points should be awarded only for 0 mismatch combinations, with the number of points to be determined by the OPTN. (Transplant News, April 30/May 15, 2002)