Pediatric impacts of multiorgan transplant allocation policy in the United States

BackgroundMultiorgan transplantation is increasingly common, driving recent increased attention to multiorgan allocation policies. MethodsIn this review, we summarize current multiorgan transplant allocation policies in the United States, with attention to recent and proposed changes and their impact on pediatric candidates. ResultsExisting multiorgan transplant policies attempt to balance equity and utility. Currently, there are clear allocation policies for some, but not all, multiorgan transplant combinations, and there are no mandatory outcomes reporting. Multiorgan candidates are prioritized above all kidney-alone transplant candidates, which negatively affect pediatric kidney transplant wait times. Pediatric candidates are typically exempt from multiorgan listing criteria. ConclusionMultiorgan transplant allocation presents unique challenges for policy development. As the United States Network for Organ Sharing begins exploring continuous distribution allocation, multiorgan allocation will require special consideration and the development of clear and equitable policies.