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Risk Indices in Deceased-donor Organ Allocation for Transplantation

Review From an Australian Perspective

Ling, Jonathan E. H., FRACP1; Fink, Michael, FRACS2; Westall, Glen3; Macdonald, Peter4; Clayton, Philip A., FRACP5; Holdsworth, Rhonda, BSc6; Opdam, Helen, FRACP7; Polkinghorne, Kevan R.1; Kanellis, John, PhD1

doi: 10.1097/TP.0000000000002613
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Over the last decade, organ donation and transplantation rates have increased in Australia and worldwide. Donor and recipient characteristics for most organ types have generally broadened, resulting in the need to consider more complex data in transplant decision-making. As a result of some of these pressures, the Australian software used for donor and recipient data management is currently being updated. Because of the in-built capacity for improved data management, organ allocation processes will have the opportunity to be significantly reviewed, in particular the possible use of risk indices (RIs) to guide organ allocation and transplantation decisions. We aimed to review RIs used in organ allocation policies worldwide and to compare their use to current Australian protocols. Significant donor, recipient, and transplant variables in the indices were summarized. We conclude that Australia has the opportunity to incorporate greater use of RIs in its allocation policies and in transplant decision-making processes. However, while RIs can assist with organ allocation and help guide prognosis, they often have significant limitations which need to be properly appreciated when deciding how to best use them to guide clinical decisions.

1 Department of Nephrology, Monash Medical Centre, Melbourne, VIC, Australia.

2 Victorian Liver Transplant Unit, Austin Hospital, Melbourne, VIC, Australia.

3 Lung Transplant Unit, Alfred Hospital, Melbourne, VIC, Australia.

4 Cardiopulmonary Transplant Unit, St Vincent's Hospital, Sydney, NSW, Australia.

5 Department of Nephrology, Royal Adelaide Hospital, Adelaide, SA, Australia.

6 Transplantation and Immunogenetics, Services, Australian Red Cross Blood Service, Melbourne, VIC, Australia.

7 Organ and Tissue Authority, Canberra, ACT, Australia.

Received 29 July 2018. Revision received 8 December 2018.

Accepted 21 December 2018.

The authors declare no funding or conflicts of interest.

J.E.H.L. involved in literature review, wrote first draft manuscript, tables, and collated additions by all authors into final manuscript. M.F. reviewed first draft of manuscript particularly Scores Guiding Liver Transplantation and participated in writing of the paper. G.W. reviewed first draft of manuscript particularly Scores Guiding Lung Transplantation and participated in writing of the paper. P.M. reviewed first draft of manuscript particularly Scores Guiding Heart Transplantation and participated in writing of the paper. P.A.C. reviewed first draft of manuscript particularly Scores Guiding Kidney Transplantation and participated in writing of the paper. R.H. reviewed first draft of manuscript, particularly Introduction and Scores Guiding Organ Allocation, and participated in writing of the paper. H.O. reviewed first draft of manuscript particularly Introduction and Scores Guiding Organ Allocation and participated in writing of the paper. K.R.P. supervised editing of final manuscript and participated in writing of the paper. J.K. supervised editing of final manuscript and participated in writing of the paper.

Correspondence: Jonathan E.H. Ling, FRACP, Department of Nephrology, Monash Medical Centre, 246 Clayton Rd, VIC 3168, Australia. Email: Jonathan.ling@monash.edu

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