Transplantation. 98(4):458-464, August 27, 2014.
It is clearly necessary to develop clear, transparent, objective and evidence-based processes to allocate organs from deceased donors. Health care administrations round the world have risen to the challenge. Most, if not all, allocation systems for kidneys use a points-based system which gives increasing points for waiting time so that those who are disadvantaged by having a blood group or tissue type under-represented in the donor population or being highly sensitised, for example, will have access to the donor pool.
This study, from Finland, confirms previous work that longer duration of pre-transplant dialysis is associated with an increased risk of death after transplant, primarily from cardiovascular complications. A causal relationship seems likely but can only be inferred from these and other correlations.
This observation then begs the question, why do we not use donated kidneys more effectively to save and improve patients’ lives and revise the current approach which effectively means that we are building in delay to allocation and so encouraging worse outcomes? Of course, this is a simplistic and intentionally controversial challenge but maybe there is a need to have review, involving donor families, patients before and after transplant, health care professionals, lawyers and ethicists as well as the public, to review again our assumptions and see whether change or modification is required.