Board revises kidney policy to boost minority transplants

Published on: Thursday, November 14, 2002

Alexandria, Va. - The OPTN/UNOS Board of Directors voted at its meeting today to increase minority access to kidney transplants by revising allocation priority for tissue matching.  Data suggest the policy change would allow more than 200 additional kidney transplants annually for minority patients. 

"We feel that issues of justice, fairness and equity are clearly addressed by this proposal," said Winfred Williams, M.D., chairman of the OPTN/UNOS Minority Affairs Committee.  "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 human leukocyte antigen (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 for transplantation. 

However, HLA patterns are inherited, which means some minority patients are less well matched with Caucasian donors.  As a result, the requirement for HLA matching may contribute to longer waiting times for minority kidney transplant candidates.  Recent scientific analysis indicated that HLA matching priority could be reduced somewhat while maintaining a high rate of long-term graft survival (continued function of the transplanted kidney).

Three pairs of HLA antigens are compared between donor and patient.  Under the revised policy, allocation priority will only be given for patients whose antigens match one or both donor antigens at one specific pair, known as the "DR locus."  National priority will also continue to be given to patients who have a "perfect" HLA match with a specific donor

The policy will be implemented as soon as it can be programmed into the computerized system that matches donors and recipients nationwide.  In addition, the Board resolved to further study the impact of the revised priority and may consider later modification.

In other action, the Board approved an adjustment to liver allocation priority for patients with hepatocellular carcinoma (HCC) needing a liver transplant.  The adjustment is intended to keep the priority for HCC patients equivalent to that of those classified under the standard system. 

"The OPTN and UNOS have - and will continue to - monitor the priority for all diagnoses," said Richard Freeman, M.D., chairman of the OPTN/UNOS Liver and Intestinal Organ Transplantation Committee.  "We have found upon early review that the priority for HCC liver candidates was not in proportion to that of candidates with other diagnoses."

The OPTN/UNOS Board of Directors establishes uniform policies to govern organ procurement, distribution and transplantation for the United States.  The OPTN/UNOS Board also manages the nation's Organ Procurement and Transplantation Network under contract with the Health Resources and Services Administration of the U.S. Department of Health and Human Services.  UNOS is a Richmond-based, private non-profit organization linking all members of the organ procurement, transplantation and histocompatibility communities.