Revamped Rationing of Renal Resources: Kidney Allocation in Search of Utility and Justice for All

The widening gap between patients in need of a kidney transplant and the finite number of transplantable deceased donor organs resulted in critical review of kidney allocation policy in the USA. The process to reach consensus for change required compromise between arguments for utility and equity. Important amendments to address shortcomings of the old system and projected outcomes of the new system are reviewed. Potential unintended consequences and practical considerations to facilitate implementation of provisions intended to enhance utility and increase access to transplant for population subgroups in the new system are explored. Granular metrics provide built-in flexibility for the new system, making it amenable to modification based on outcomes.