Greater complexity and monitoring of the new Kidney Allocation System: Implications and unintended consequences of concentric circle kidney allocation on network complexity
Greater complexity and monitoring of the new Kidney Allocation System: Implications and unintended consequences of concentric circle kidney allocation on network complexity
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DOI：
10.1111/ajt.16441
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发表时间：
2021-01-02
影响因子：
8.8
通讯作者：
Mohan, Sumit
中科院分区：
文献类型：
--
作者：
Adler, Joel T.;Husain, Syed A.;Mohan, Sumit
美国的已故供者肾脏分配系统经历了几轮迭代变化，但这些变化并不是为了解决移植机会的地理差异而设计的。新的分配制度预计将于2020年12月开始实施，将“本地分配”的定义从捐赠服务区更改为源自捐赠医院的250海里圆。虽然其他实体器官也采取了类似的方法，但肾移植中心和移植候选者的数量增加可能会产生不同的后果。在这里，我们讨论了分配复杂性的惊人增加，讨论了一些可能的有意和意外后果，并提出了监控新系统的指标。
The deceased donor kidney allocation system in the United States has undergone several rounds of iterative changes, but these changes were not explicitly designed to address the geographic variation in access to transplantation. The new allocation system, expected to start in December 2020, changes the definition of "local allocation" from the Donation Service Area to 250 nautical mile circles originating from the donor hospital. While other solid organs have adopted a similar approach, the larger number of both kidney transplant centers and transplant candidates is likely to have different consequences. Here, we discuss the incredible increase in complexity in allocation, discuss some of the likely intended and unintended consequences, and propose metrics to monitor the new system.