Solutions to inequities in kidney transplant allocation

Nov 7 2008

Depending on where they live in the United States, patients needing a kidney transplant can wait just one year for a deceased donor's kidney or up to 10 years.

The causes and implications of these inequities will be discussed at the American Society of Nephrology's 41st Annual Meeting and Scientific Exposition in Philadelphia.

Because wait times for kidney transplants throughout the United States show wide variation, researchers and clinicians are working to understand the basis for these inequities and to find ways to remedy them. In a program moderated by Hassan N. Ibrahim, MD, FASN, of the University of Minnesota in Minneapolis, Minnesota, and Todd Pesavento, MD, of Ohio State University in Columbus,Ohio, experts will discuss the issues involved in allocation of deceased donor organs and the possible solutions in the near- and long-term future.

Alan Leichtman, MD, of the University of Michigan in Ann Arbor, Michigan, will present the latest information regarding current organ allocation policies, highlighting the disparities and differences between regions in terms of wait times. He also will describe the simulation modeling in support of the latest initiatives across the country to change current organ allocation practices.

Next, Ajay Israni, MD, MS, of the Hennepin County Medical Center in Minneapolis, Minnesota, will discuss various innovations related to living related transplantation. In particular, he will present information on donor exchange programs, which match an immunologically incompatible patient-donor pair with another such incompatible patient-donor pair. Through such a program, the two patients exchange donors thereby resulting in two compatible patient-donor pairs.

Viken Douzdjian, MD, of the Legacy Good Samaritan Hospital in Portland, Oregon, will then provide an overview of priorities for multi-organ donation, where patients receive multiple organs—such as a heart, a liver, and a kidney—at one time. These complex operations, which are performed on very sick patients, require sophisticated medical expertise and advanced technologies.

Finally, Akinlolu Ojo, MD, of the University of Michigan will spell out the alphabet soup of kidney transplantation. SCD, ECD, and DCD are commonly used abbreviations among experts in the field of transplantation. An SCD, or standard criteria donor, is a healthy person who is aged 18 to 60 years. An ECD, or an expanded criteria donor, is an older donor whose kidney function is not completely normal. Often patients in need of a kidney transplant agree to accept an organ from an ECD because it would increase their chance of having a transplant due to the national shortage of kidneys. Finally, DCD stands for donation after cardiac death. Kidneys obtained after cardiac death, particularly in the controlled setting of an intensive care unit, are now being realized as a potentially valuable resource for patients in need of transplants.

Together, the presenters in this symposium will provide a broad overview of various important issues stemming from shortcomings in current allocation policies of deceased donor kidneys. The program, "Allocation of Deceased Donor Organs for Renal Transplantation," will be presented on Thursday, November 6 from 4:00 p.m. – 6:00 p.m. in Room 113 of the Pennsylvania Convention Center in Philadelphia, PA.