Renal transplantation: the last iteration of the rest of the world.

PURPOSE OF REVIEW: Renal transplantation systems across the world aim to achieve an optimal balance between fair access to deceased donor kidney transplants (equity) and efficient use of organs (utility). Kidney allocation systems are measured across a host of metrics, and there is no single agreed upon definition of success, which looks different for each system depending on the desired balance between equity and utility. This article evaluates the United States renal transplantation system's efforts to balance equity and utility while drawing comparisons to other national systems.

RECENT FINDINGS: The United States renal transplantation system is expected to undergo major changes with the transition to a continuous distribution framework. The continuous distribution framework removes geographic boundaries and takes a flexible and transparent approach to balancing equity and utility. The framework leverages transplant professionals and community members input with mathematical optimization strategies to inform weighting of patient factors to allocate deceased donor kidneys.

SUMMARY: The United States' proposed continuous allocation framework lays the groundwork for a system allowing transparent balancing of equity and utility. This system approach addresses issues common to those in many other countries.