Matching graft to recipient by predicted survival: can this be an acceptable strategy to improve utilization of deceased donor kidneys?

A new kidney allocation scheme is needed to address the current shortage of deceased donor kidneys for transplantation in the United States. With this goal in mind, we have derived a novel utility-based system to balance supply and demand. Our system uses a North American–based recipient risk score and the deceased donor score to maximize the total number of years of renal allograft function as a means to improve allocation of kidneys from deceased donors. Essentially, donor renal allografts are matched to a wait-listed candidate with similar predicted survival, which poses an ethical issue. However, this novel utility-based system is practical and could improve deceased donor renal allocation by minimizing both waste and need for retransplantation.