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Kidney Transplant Committee Proposes Changes Aimed at Better Use of Donated Organs

After nine years of fitful work, the governance committee that oversees kidney transplants in the United States proposed a series of tweaks on Friday aimed at making better use of the country’s desperately inadequate supply of deceased-donor organs.

Central to the plan is a new index for better estimating the quality of the more than 14,000 kidneys recovered from dead donors each year. The top 20 percent of kidneys, as measured by the index, would be directed to those candidates expected to live the longest after a transplant — typically younger patients.

For that fortunate one-fifth, it would be a significant departure from the current wait-list system, which operates largely on a first-come-first-served basis. But for the other 80 percent, there would be little change in a process that has been criticized for the number of patients who die while waiting for a match, deep geographic disparities in waiting times and inefficiencies that lead to hundreds of viable organs being discarded each year.

Using computer simulations, the plan’s architects estimated the changes would produce an additional 8,380 years of life from one year of transplants. That is about half the number of years generated by a plan previously considered by the committee, which would have matched many kidneys to recipients by age. That plan was abandoned after federal officials warned last year that it would violate age discrimination laws.

The new proposal, issued by the kidney transplantation committee of the United Network for Organ Sharing, is open for public comment until Dec. 14. The committee will then consider revisions and make recommendations to the network’s full board, which could vote on the plan at a meeting in June. The network, based in Richmond, Va., manages the country’s Organ Procurement and Transplantation Network under a federal contract with the Department of Health and Human Services.

More than 93,000 people are waiting for a kidney transplant, many of them tethered to dialysis three times a week. Last year, 16,813 patients received transplants — 11,043 of them from dead donors — while 4,720 on the list died.

The organ sharing network has long acknowledged that the current system does not make maximum use of available kidneys because it can drive old organs to young recipients, who may outlive them, and vice versa. The allocation of other deceased-donor organs, like hearts, livers and lungs, was revised years ago to account for factors like medical urgency and expected survival time.

Kidneys from older donors, or those with certain health problems, are offered to candidates who have registered as being willing to consider them, but there is no requirement to accept them. That was one of many factors leading to the discard of 2,644 deceased-donor kidneys in 2011.

The current system, the committee said in its proposal, “does not recognize that all candidates do not have the same ability to survive the wait.”

The new allocation plan seeks to eliminate the worst mismatches between donors and recipients by directing the highest quality kidneys to the candidates likely to live the longest, said Dr. John J. Friedewald, the committee’s chairman and a transplant nephrologist at Northwestern University’s Feinberg School of Medicine. In addition, the lowest-quality kidneys would be offered to candidates on a wider geographic basis than they are now, in the hope of finding willing recipients.

While Dr. Friedewald acknowledged that many of the patients most likely to benefit from the changes would be younger ones, he said it would still be possible for some in their 40s and 50s to make the cut.

“We decided that a small change in allocation differences would be worth the massive number of extra life years we could attain under the system,” Dr. Friedewald said in a conference call. “By providing long-lived organs to long-lived recipients, we prevent returns to the wait list, and by preventing returns to the wait list we actually make more organs available for other candidates.”

Another change would alter the way time on the wait list is measured for candidates on dialysis. Their time on the list would start when they begin dialysis rather than when they sign up for the transplant list. This is expected to help those from underserved groups who may not receive good information early about transplantation as an option.

The proposal would also amend the way priority is given to candidates who are particularly difficult to match with donor kidneys because of their blood types and biochemistry. In the past, only the most difficult matches received priority points that moved them up the wait list. Now those points will be awarded on a sliding scale based on the degree of difficulty in finding a viable match.

The plan also, for the first time, would allow candidates with blood type B, who have the longest waiting times, to receive kidneys from donors from an expanded group of blood types.

A version of this article appears in print on  , Section A, Page 13 of the New York edition with the headline: Kidney Transplant Committee Proposes Changes Aimed at Better Use of Donated Organs. Order Reprints | Today’s Paper | Subscribe

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