Kidney transplant rules may be changed

CHICAGO – If someone needs a kidney transplant today, it doesn’t matter if he or she is 25 or 60 years old. What counts is how long that person has waited for a suitable organ to become available.

That would change under a controversial new proposal by the nation’s organ transplant network unveiled Thursday in Dallas. The plan would give kidneys to patients who would live longest after a transplant, not those who have languished longest on waiting lists.

The goal is to make sure organs go to patients who can get the most benefit from a kidney transplant, extending more people’s lives. But experts worry that older patients would be far less likely to get transplants if the plan is adopted.

“The thought is, if one person can live 15 years after a kidney transplant and another person can live five years, the organ should go to the person who lives the longest,” explained Dolph Chianchiano, vice president of health policy for the National Kidney Foundation.

The change would apply only to kidneys from deceased donors; organs from living donors wouldn’t be affected.

The proposal, which may be altered and would not take effect until December at the earliest, comes from the Organ Procurement and Transplantation Network, which oversees all transplants in the U.S., and the agency that runs it, the United Network for Organ Sharing.

It would assess the benefit of a kidney transplant by estimating “extra years lived” – how long a patient with failing kidneys might expect to survive after a transplant versus how long the same patient might live on dialysis treatment.

Under this system, younger patients who haven’t suffered the effects of age and attendant medical deterioration would be favored over patients in their 50s and above. Chances for a transplant would also worsen for older people with type 2 diabetes, an increasingly common cause of kidney failure and source of medical complications such as hypertension and heart disease.

The change strikes some transplant experts and patients as unfair and potentially dangerous.

“How do you tell a 55-year-old: Too bad, you’re too old, you’re not getting a kidney because your life expectancy isn’t that of a 35-year-old?” asked Dr. Michael Abecassis, chief of organ transplantation at Northwestern’s Feinberg School of Medicine. “How’s the AARP going to react to that?”

But the current system for distributing kidneys has problems, too. People with the most urgent medical needs are often not at the top of waiting lists. Increasingly, those spots are occupied by elderly individuals with underlying medical conditions such as heart disease or hypertension, who may not survive long under any circumstances.

Inequalities also occur in the system because the supply of kidneys, the demand for organs and the availability of medical services vary by location, noted Dr. Michael Shapiro, chief of transplantation at Hackensack University Medical Center in New Jersey.

For instance, waits for kidney now average 8 to 10 years in New York City but only 2 years in Albany, N.Y.

Data released at the Dallas meeting suggest transplant patients in the U.S. would live an extra 11,457 years under the new allocation scheme because more people would receive kidneys that would last longer.