The kidney recovery rate associated with deceased donors has increased after the establishment of the Korean Network for Organ Sharing (KONOS). And the KONOS organ allocation system gives priority to candidates affiliated with a Hospital based Organ Procurement Organization (HOPO) and/or donor recovery hospital. Regardless of whether or not this organ allocation system is fair, it can make an important impact on the waiting time for an organ transplant.

A total of 157 deceased donor kidney transplantations were performed at Severance Hospital between January 2006 and April 2011. The recipients of these transplantations were retrospectively divided into five groups according to their allocation types; general allocation group (GA, n=54), HOPO priority group (HP, n=65), zero antigen mismatching group (ZM, n=23), marginal donor allocation group (MD, n=7), and the combined organ transplant allocation group (CT, n=8). The five groups were assessed in terms of their waiting time for organ allocation, cold ischemia time, and post-transplant graft outcome.

Mean waiting time for organ allocation of the HP group (69.5±27.4 months) was significantly shorter than for the GA group (90.0±34.0 months)(P<0.05). However, the degree of HLA mismatching was not different between each group. The cold ischemia time for the HP group (301.5±133.9 min) was significantly shorter than all other groups, except for the ZM group. There were no differences between groups in terms of acute rejection episodes, delayed graft function events or graft survival rates.

Our retrospective analysis of the kidney allocation pattern showed that there were disparities in distribution by priority of allocation. We should make a consensus within the Korean transplant society in order to further develop the allocation system to decease donor kidney transplantation time.