Section 2: Organ Allocation Matching graft to recipient by predicted survival: can this be an acceptable strategy to improve utilization of deceased donor kidneys?

A new kidney allocation scheme is needed to address the current shortage of deceased donor kidneys for transplantation in the United States. With this goal in mind, we have derived a novel utility-based system to balance supply and demand. Our system uses a North American–based recipient risk score and the deceased donor score to maximize the total number of years of renal allograft function as a means to improve allocation of kidneys from deceased donors. Essentially, donor renal allografts are matched to a wait-listed candidate with similar predicted survival, which poses an ethical issue. However, this novel utility-based system is practical and could improve deceased donor renal allocation by minimizing both waste and need for retransplantation. © 2008 Elsevier Inc. All rights reserved. Unfortunately, a large disparity exists between the supply and the demand for transplantable organs. In the United States, our government has struggled to devise an allocation scheme that would equilibrate the supply and demand for organs in this country. Thus, far success has not been achieved. The growing waiting list and waiting time for renal