Deceased organ donation: laboratory testing and histocompatibility assessment in Korea

Histocompatibility testing is essential for ensuring both safety and fairness in deceased donor organ transplantation. In Korea, such testing is strictly regulated under the Organ Transplant Act and centralized within organ procurement organization laboratories. Standardized evaluations include ABO blood typing, infectious disease screening, human leukocyte antigen (HLA) typing, and crossmatching. Current allocation policies rely on low-resolution HLA typing and mandatory complement-dependent cytotoxicity crossmatch, with limited accommodations for highly sensitized patients; however, these measures remain inadequate to resolve prolonged waiting times and inequities. The integration of calculated panel-reactive antibody and virtual crossmatching provides opportunities to improve allocation fairness, reduce cold ischemic time, and minimize unnecessary crossmatches. This review outlines the Korean system of histocompatibility testing in deceased donor transplantation, highlights current challenges, and explores potential strategies for future improvement.