Madrigal-Bustamante JA, Cardoso-Arias R, Juárez-Enríquez D, Cantú-Quintanilla GR

Language: Spanish
References: 8
Page: 41-46
PDF size: 190.22 Kb.

ABSTRACT

Deceased donor kidney allocation is an essential part of the organ donation and transplant process. Most kidney allocation systems worldwide are based on a score method with specific criteria and rules oriented to justice, equity and efficiency. Mexico doesn’t have this type of allocation system on an institutional, regional or national level. We evaluated allocation criteria used by the main deceased donor kidney transplant centers in the country, availability of histocompatibility tests and their posture on score-based kidney allocation systems, to generate a bioethics and medical discussion about current allocation practices and the subject’s future in Mexico. The criteria used in a consistent way among programs are waiting list time, availability of vascular access (urgency criteria) and adherence to treatment. Most programs don’t consider histocompatibility tests (HLA mismatch, DSA), donor and recipient sex, type of dialysis, ESRD etiology, and economic resources. A future system should consider time spent on dialysis, donor and recipient age, PRA percentage, DSA presence, living donor availability, family support network and presence of comorbidities. Regarding histocompatibility tests, 71% contemplate them as a requisite in their protocols, and 85% have a laboratory available: 57% are institutional and 29% regional or state-based; 83% are public and 17% private. 71% of the programs agree on merging waitlists on a state-based or regional level, and 86% agree on participating in a pilot program. The goal of this study is to support the planning and design of a new score-based kidney allocation system that allows a more efficient and transparent decision, to obtain better results and a fair distribution of a scarce resource such as deceased donor kidneys.

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