Who Will get the Kidney Transplant?
By: Dr. Ivan Begov
Too many people in the United States are suffering from End Stage Kidney Disease requiring dialysis. This is a condition that could be cured by transplanting a kidney either from a deceased donor or from a friend or relative. However, there are almost 100,000 people waiting for a kidney transplant at any given time, while only around 16,000 organs are being donated per year. This overwhelming shortage of donors is leading to long waiting times on the transplant list (about 5 years in Illinois).
As some of you may already know, the new Kidney Allocation System is coming up in just a few months at the end of 2014 which will make changes to how kidneys are distributed. Why change the rules? Well, while there are certain exceptions, currently it’s mostly a “first come, first served” policy of distributing kidneys. This means a perfect kidney from a 17-year-old could end up going to a 79-year-old person with heart disease and diabetes while a young patient may get an older kidney. With the severe shortage of organs, most people agree it makes sense to get as many years out of this limited resource as we can. Here are the main changes:
New start time for waiting:
The clock starts on the day patients start dialysis, not just when they are evaluated and put on the formal waiting list. For example, if Joe started dialysis 18 months ago but his listing was delayed for 4 months due to him not being able to get in to see the cardiologist for medical clearance, he will still get credit for those 4 months which under the current system would be lost. Patients are still allowed to get on the waiting list when their kidney function is below 20% even if they are not on dialysis yet.
Life-expectancy matching:
Every donor kidney will get a score. The new rules will match the best kidneys with the top 20% of people with the longest life expectancy. Who will benefit? Likely younger, healthier patients. The flipside is if you are an older patient with diabetes, you may be at a disadvantage.
Reduced waste:
Currently, kidneys which have a lower score (lower functioning) often are turned down and go to waste. In the new system, they will be offered in a wider geographical region to those who are willing to accept this risk and get a kidney faster (For example, Mildred, a 78-year-old lady with significant heart disease, who has a relatively short life expectancy could choose this option).
Priority for Living Organ Donors:
In the rare instance where a living donor (of any organ) needs a kidney transplant, he or she will get priority in obtaining a kidney faster. Most people would agree that this is ethical and fairly honors the gift that person made .
Greater access for disadvantaged patients:
Currently patients with blood type B and those who have antibodies that cause immune sensitivity (such as patients who have needed blood transfusions in the past) wait the longest for new kidneys. The new system would give those patients priority to try to decrease their waiting time.
I’m sure there will be different reactions to the above changes. While the new system may somewhat help alleviate the shortage of deceased donor kidneys, you as a patient can also play an active role by having a family member donate a kidney directly to you. This can be a very difficult decision for both of you. However, realizing that living donor kidneys, in general, last longer than deceased donor kidneys, and getting educated on the process of donor evaluation can help you understand that the risks are relatively small and the potential benefit of not needing dialysis and prolonging someone’s life is priceless. Please consider becoming a donor! I myself am a registered donor and I encourage all of you to do the same.
