In 2004, it was agreed that a new allocation scheme for kidneys from deceased heart-beating donors was required in the United Kingdom to address observed inequities in access to transplant. The 2006 National Kidney Allocation Scheme (2006 NKAS) was developed to meet agreed objectives and preparatory work included a review of the criteria for human leukocyte antigen (HLA) matching and simulation evidence about the effectiveness of alternative schemes.
The 2006 NKAS gives absolute priority to all 000 HLA-A, -B, -DR–mismatched patients and well-matched pediatric patients (<18 years), and then a points score defines priorities for allocation with waiting time being most influential. Points for age and HLA mismatch are linked in a novel approach to ensure well-matched transplants for younger patients while recognizing that HLA matching is less important for older patients as retransplantation is less likely to be required. To improve equity for difficult to match patients, rare HLA specificities were defaulted to more common, related specificities.
After 3 years, the scheme is already making good progress in achieving its objectives, with overall results similar to those observed in the simulations. There has been a significant benefit for patients waiting more than 5 years for transplant. A number of other advantages of the scheme are also apparent with equity of access improving in many respects, including the achievement of equity of access to transplant for HLA-DR homozygous patients, but geographical inequity of access will take a number of years to address fully.
1 NHS Blood and Transplant, Bristol, United Kingdom.
2 Nuffield Department of Surgery, Oxford Transplant Centre, Churchill Hospital, Oxford, United Kingdom.
3 Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom.
4 Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
5 Department of Health, Wellington House, London, United Kingdom.
6 On behalf of the Kidney Advisory Group of NHS Blood and Transplant (see Appendix to this article).
R.J. Johnson and S.V. Fuggle contributed equally to the manuscript and are considered to be joint first authors.
7 Address correspondence to: Rachel Johnson, M.S.c., Organ Donation and Transplantation, NHS Blood and Transplant, Fox Den Road, Stoke Gifford, Bristol BS34 8RR, United Kingdom.
Received 8 October 2009. Revision requested 8 October 2009.
Accepted 15 October 2009.