Update on the Development of a New U.S. Kidney Transplant Allocation System

A substantial revision of the adult kidney allocation system in the U.S. is currently underway. The proposed revised system combines the new concepts of life years from transplant (LYFT), the donor profile index (DPI), and dialysis time (DT) into an overall kidney allocation score (KAS). The KAS for the first time integrates a measure of medical utility into kidney allocation. A KAS-based system holds the promise of improved efficiency, increased waitlist access and a gain in the number of life-years achieved from transplantation. This article discusses the rationale for the development of a new system, the state of the KAS proposal, and the challenges that remain to implementation of a new kidney allocation system.