Background: The Organ Transplantation Act of Korea was amended in October 2018 to grant more priority to pediatric patients on the kidney waitlist. The amended decree states that one kidney from brain-dead donors under age 19 (previously age 11) must be initially allocated to a waitlisted patient under age 19. The aim of this study was to analyze the change in allocation pattern of kidneys from pediatric donors following implementation of the new policy.
Methods: Data was extracted from the KONOS database and included donor and recipient information of kidney transplants from pediatric donors (age < 19) from October 2014 to September 2020.
Results: There were 2958 brain-dead donors from October 2014 to September 2020. 163 donors were under age 19 (163/2958, 5.5%). The study period was divided into 2 periods: before policy change (October 2014 to September 2018) and after policy change (September 2018 to September 2020). The proportion of donors under age 19 was not different between the 2 periods (5.9% vs. 4.4%). 256 kidneys from 163 pediatric donors were allocated to waitlist patients. The proportion of kidneys allocated to recipients under age 19 was significantly higher after policy change (59/65, 90.8%) compared to before policy change (28/191, 14.7%, p < 0.01). The days on waitlist of adult recipients (age 19 or older) of pediatric donor kidneys were similar before and after policy change, while the days on waitlist of pediatric recipients significantly increased. However, the days on waitlist of pediatric recipients were significantly shorter than adult recipients, both before (670.0 ± 472.2 vs. 2038.0 ± 801.4 days, p < 0.01) and after (929.4 ± 451.5 vs. 1620.0 ± 942.1 days, p < 0.01) policy change.
Conclusion: A sharp increase in proportion of pediatric kidney recipients from pediatric donors was observed following implementation of amended allocation policy in October 2018.