Soon kidney transplant recipients would be younger under a proposal being considered by the nation’s organ transplant network. This would replace the current ‘first-come-first-served’ system and is intended to provide better matches between the life expectancies of recipients and the functional life of donated kidneys.
Dr. Richard N. Formica, a transplant surgeon at Yale University and a member of the panel that wrote the proposed policy said, “Right now, if you’re 77 years old and you’re offered an 18-year-old’s kidney, you get it… The problem is that you’ll die with that kidney still functioning, while a 30-year-old could have gotten that kidney and lived with it to see his kids graduate from college.”
According to the proposal patients and kidneys would each be graded, and the healthiest and youngest 20 percent of patients and kidneys would be segregated into a separate pool so that the best kidneys would be given to patients with the longest life expectancies. The other 80 percent of patients would be put into a pool from which the network that arranges for organ matches, called the United Network for Organ Sharing. The network would try to ensure that the age difference between kidney donors and recipients is no more than 15 years.
Kenneth Andreoni, an associate professor of surgery at Ohio State University who chairs the committee that is reviewing the system for the United Network for Organ Sharing (UNOS), a Richmond- based private non-profit group contracted by the federal government to coordinate organ allocation said, “We’re trying to best utilize the gift of the donated organ…It’s an effort to get the most out of a scarce resource.”
On one hand transplant surgeons and medical ethicists are supporting this proposal but recipients and legislators are unhappy. A previous proposal to better match the health of patients and donor kidneys was scrapped in 2005 after the network was flooded with negative comments.
Lainie Friedman Ross, a University of Chicago bioethicist and physician said, “The best kidneys are from young adults under age 35 years. Nobody over the age of 50 will ever see one of those…There are a lot of people in their 50s and 60s who, with a properly functioning kidney, could have 20 or more years of life. We’re making it harder for them to get a kidney that will function for that length of time. It’s age discrimination.”
Arthur C. Caplan, a University of Pennsylvania bioethicist said, “It’s a big shift… For a long time, the whole program has been oriented toward waiting-list time. This is moving it away from a save-the-sickest strategy to trying to get a greater yield in terms of years of life saved.”
The 30-member UNOS Kidney Transplantation Committee, which has been reviewing the system for about six years, last week began circulating for public comment a 40-page document outlining possible revisions. M. Jill McMaster, a UNOS board member representing the public, acknowledged that the new system would put older people at a disadvantage, but she argued that it is necessary saying, “I'm 60 years old, and I have a transplant. But if I were to need a second transplant, I wouldn’t have a chance of getting the best organs, whereas in the past I did have a chance… What we’re asking those on the list to do is hard when you are sick, which is to look at the needs of everybody. I think it’s the right thing to do.”
More than 110,000 Americans are listed as waiting for organs, including more than 87,000 who need kidneys. Only about 17,000 Americans get kidneys each year, and more than 4,600 die because they did not get one in time. The public has until April 1 to comment on the idea, which would make the kidney system more similar to those used to allocate livers, hearts and lungs. The board could approve final changes by June 2012.
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