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Effectiveness and Equity in Kidney Allocation

Hora: 13.30

Lugar: Sala 401, Beauchef 851

Speaker: Joel Joris Van de Klundert, UAI

Abstract: chronic kidney disease (CKD) affects more than 1 out of 10 people worldwide and its prevalence increases steadily. In 2019, CKD was the 11th most common cause of death globally and the 4th most common cause of death in Chile. Addressing the burden of disease of CKD and providing access to treatment for the increasing patient volumes form major health systems challenges in Chile and elsewhere. End Stage Renal Disease can be treated by dialysis and by transplantation. Compared to dialysis, transplantation offers better expected quality of life, longer life expectancy, and significantly lower average cost. Unfortunately, the availability of kidneys for transplantation is limited and many patients pass away while being wait listed for transplantation, as is also evidenced by the aforementioned mortality data.

Traditionally, organs for donations are recovered from deceased donors. The supply of organs for such “deceased donation” has however typically failed to match demand, which causes delicate allocation problems with need to consider fairness of allocation, avoiding inequities among patient sub populations. These decisions are complicated by incompatibility between organs and recipients because of ABO (bloodtype incompatibility) and HLA incompatibility. As healthy
human bodies possess two well-functioning kidneys whereas one suffices, living kidney donation has developed as an alternative to deceased donation (and dialysis). Living donation is the most effective (e.g. in terms of expected survival) and lowest cost. Kidney exchange programs
(KEPs) facilitate patients with incompatible willing donors to receive a transplant by reallocating donors. Optimization in KEPs however typically focuses on maximizing the number of transplant instead of effectiveness.

In this talk we consider models maximizing equity in deceased donor kidney allocation with a case study in the US and models optimizingeffectiveness of living donor kidney allocation in kidney exchange program, with a case study in the Netherlands. We end with briefly discussing advances in HLA compatibility testing that may enable further optimization of effectiveness and equity.

Organiza: ISCI