Malaysian Organ Sharing System

40. MALAYSIAN ORGAN SHARING SYSTEM (MOSS)

Malaysian Society of Nephrology (MSN) and the Ministry of Health of Malaysia initiated the development of a national organ sharing network in 1999, named the Malaysian Organ Sharing System (MOSS). This system is to ensure an equitable distribution of cadaveric organs.
Presently only cadaveric kidneys are distributed based on the criteria drawn up by the MOSS committee. Any Malaysian citizen with end stage renal failure can register with MOSS as a potential renal recipient.

40.1 Exclusion criteria
Patients aged less than 2 years old or above 60 years old are disqualified. Patients with any disease or illness with expected survival of less than 5 years or with a resultant poor quality of life are not eligible. This will include the following patients:
40.1.1 Positive HIV serology

40.1.2 Positive hepatitis Be antigen

40.1.3 Active liver disease

40.1.4 Severe cardiovascular/cerebrovascular/pulmonary disease

40.1.5 Dementia or psychosis with no underlying treatable disease

40.1.6 Malignancy of limited life expectancy

40.1.7 Oxalosis (not contraindicated for combined liver and
kidney transplantation)

40.1.8 Active substance abuse

40.2 Preregisteration assessment
40.2.1 Cardiac assessment (including cardiac stress test and echocardiogram) is required for asymptomatic, nondiabetic patients > 55 years old or diabetic patients > 35 years old.

40.2.2 Symptomatic or asymptomatic patients with positive stress test should be further assessed by a cardiologist and treated appropriately.


40.3 Criteria for prioritisation
With rare exception, the donor and recipient should be the same ABO blood group type. One of the two kidneys will be allocated to the procurement centre.
Candidates with limited life expectancy (<1 year) without renal transplant will be placed into the medical emergency list (SOS). This decision can only be made by a nephrologist. Candidates on the SOS list will receive top priority in receiving a cadaveric kidney.
Candidates will be selected based on the following scoring system:
40.3.1 HLA antigens (A, B and DR) matching * (12 points)

40.3.2 Panel reactive antigen (10 points) *

40.3.3 Waiting time (20 points)

40.3.4 Logistic score (6 points)

*Due to logistic reasons, HLA antigens & PRA are presently not used as selection criteria.


Reference
Wong HS. Malaysian Organ Sharing System. Med J Malaysia 1999; 54 : 537-538