Public Release: 

Who receives a kidney transplant first?

Fairness of kidney allocation could shake public trust

Blackwell Publishing Ltd.

Pittsburgh, Pa. - May 01, 2007 - While the field of transplantation is quite young, substantial advancements and success have led to the current imbalance between the supply of organs and the demand for them. The United Network for Organ Sharing (UNOS) coordinates the nation's transplant system through a point system based primarily on wait time, sensitization and HLA matching.

When a match occurs, the kidney is offered to the person at the top of the national list. A recent editorial in the American Journal of Transplantation discusses the fairness and equality in kidney allocation, particularly as UNOS is reevaluating its allocation system and will receive recommendations from a sub-committee this year.

"The issue of the allocation of deceased donor organs is not new, and there have been two somewhat conflicting philosophical approaches," says author Ron Shapiro, M.D. One states that organs are scarce resources and should be allocated preferentially to the lower risk candidates to maximize the longevity of the transplanted organ. The second strives to maximize access for all potential candidates and utilizes waiting time as an important criterion. These correspond to the "utility" versus "equity" views.

Concerns have been raised that there will be less equality in the new allocation system, even though it should be emphasized that no formal proposal has been made to date. The debate is only further complicated by the reality that deceased donor kidneys are variable in their quality - while patients, to a large extent, rely on their doctors to make appropriate decisions for them regarding candidacy and allocation.

Patients have an expectation that the system will be fundamentally fair, and any modification to the system that may be perceived as unfair runs the risk of undermining patient confidence. "Transplantation is the only technologically advanced field of medicine that is totally dependent on public understanding and support, for without donors and recipients, transplantation would simply not exist," says Shapiro.


The research and viewpoints expressed in the article are those of the author and do not reflect the opinions of the journal or the affiliated societies.

This study is published in the May issue of American Journal of Transplantation. Media wishing to receive a PDF of this article may contact

You can also review the Emory Algorithm from a five-year Emory University study which is being considered as part of a new kidney allocation system. Read the study in the October 2006 issue of the American Journal of Transplantation.

Ron Shapiro, M.D. is Professor of Surgery at the University of Pittsburgh. He can be reached for interview at

To speak with Phil Halloran, editor-in-chief of AJT, about this article and topic, attend the American Transplant Congress from May 5 -May 9 in San Francisco.

The American Journal of Transplantation serves as a forum for debate and re-assessment and is a major new platform for promoting understanding, improving results and advancing science in this dynamic field. Published monthly, the journal provides an essential resource for researchers and clinicians around the world. For more information, please visit:

The American Society of Transplant Surgeons is dedicated to excellence in transplantation surgery through education and research with respect to all aspects of organ donation and transplantation so as to save lives and enhance the quality of life of patients with end stage organ failure. For more information, please visit

The American Society of Transplantation is dedicated to advancing the field of transplantation through the promotion of research, education, advocacy, and organ donation to improve patient care. Please visit to learn more.

Blackwell Publishing is the world's leading society publisher, partnering with 665 medical, academic, and professional societies. Blackwell publishes over 800 journals and has over 6,000 books in print. The company employs over 1,000 staff members in offices in the US, UK, Australia, China, Singapore, Denmark, Germany, and Japan and officially merged with John Wiley & Sons, Inc.'s Scientific, Technical, and Medical business in February 2007. Blackwell's mission as an expert publisher is to create long-term partnerships with our clients that enhance learning, disseminate research, and improve the quality of professional practice. For more information on Blackwell Publishing, please visit or

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