Under the current allocation system for allocating kidneys from deceased donors, when a kidney becomes available, it is first offered to local transplant centers. If no one locally claims the kidney, it is then made available to the national kidney transplant list, with the person who has been waiting the longest standing first in line to receive a new organ. Not all kidneys are claimed immediately. Some centers, even those with patients at the top of the transplant list, are less likely to accept kidneys from older donors or from donors with certain medical conditions ” even though Segev says the transplant can be very beneficial for the right patient. In fact, according to the study, only 5 percent of the nation's 253 transplant centers had transplanted more than two of these harder-to-place kidneys in the previous year.

Current protocol also gives the center with the patient at the top of the list an hour to accept or reject the kidney before it goes to the next center on the list and so on and so on. A kidney ” which is stored on ice once out of the body ” could go through many centers before being claimed or could be rejected so many times that it has been out of the body too long to be usable, Segev says. It can also take more than a dozen hours from the time the organ is claimed until the time it is transplanted into the recipient. Precious time and organs are lost, he says, when these kinds of kidneys are offered to centers that experience has shown are likely to turn them down time and again.

"You can't allocate all kidneys in the same framework," says Segev, Johns Hopkins' director of clinical research for transplant surgery. "With a kidney you know will be difficult to place, we have to take a different approach. We need to get it to the most aggressive centers. Waiting for all the other centers to say no unnecessarily delays the process."

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