e. do not share a common set of characteristics identified in the model) in which
the equation was derived. A C-value of 0.75 is comparable Selleckchem AZD2014 to a model for end-stage liver disease score with C-value of 0.64, which is commonly used by many centres to prioritize patients for liver transplantation based on expected survival.38 In addition, based on DPI, the kidneys with the longest survival potential will be allocated according to the combined score of LYFT (80% of total score) and dialysis time/panel reactive antibody (PRA) (20% of total score), whereas kidneys with lower potential for long-term survival will be allocated according to dialysis time and panel reactive antibody (PRA), such that better donor kidneys are allocated to younger potential recipients, who have the longest expected LYFT. Older potential recipients (who will have a lower expected LYFT) and potential recipients with the longest dialysis time will be less likely to receive better donor kidneys but may have an advantage in being allocated shorter-lived kidneys more quickly (i.e. shorter waiting-time). Based on this allocation system using LYFT and other factors, there is a total expected increase in LYFT of 2642 years
during a single year of allocation as compared with the current allocation system in the USA. Although adoption of an allocation model based on LYFT is Y 27632 likely to increase graft longevity, this model is difficult to implement and may be perceived as being discriminatory. A perception that organ allocation is occurring in an inequitable BCKDHA manner could reduce organ
donor rates. Nevertheless, the utilization of LYFT may improve allocation based solely on age-matching, with other patient factors such as diabetes, which are known to significantly impact on graft and patient survival, are taken into account in the calculation of LYFT.39 In Australia, the initial allocation of deceased donor kidneys occurs at a national level, involving all potential recipients on the wait list. Around 20% of available deceased donor kidneys are allocated according to the Interstate Exchange Program, whereby the kidneys are shipped to potential recipients who are highly sensitized and with zero to two HLA-mismatches. However, the majority of the deceased donor kidneys are allocated locally according to primarily HLA-matching and time on dialysis. Although older donor kidneys are associated with shorter graft survival and poorer post-transplant graft function, donor issues such as age are not explicitly considered in the allocation algorithm. Some age matching still occurs, because a younger healthier potential recipient near the top of the list may decline a marginal kidney, and retain their place on the waiting list until a younger kidney becomes available.