Obesity May Contribute to Organ Shortage

PHOTO: A new government report estimates that U.S. obesity rates will balloon to 42 percent by 2030.
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WASHINGTON -- The pool of potential living kidney donors may be shrinking because of the national obesity "epidemic," researchers said here.

In a single-center study, almost a quarter of willing donors were initially excluded because they were too heavy, Dr. Mala Sachdeva of North Shore-LIJ Health System Transplant Center on Long Island, N.Y., and colleagues reported at the National Kidney Foundation meeting here.

And only a small percentage of those patients were ultimately able to lose enough weight to donate a kidney, despite their initial motivation, Sachdeva said at the group's poster presentation.

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Although there are no established national criteria, most centers exclude living donors who have a body mass index (BMI) of 35 or above, because previous work has shown poorer outcomes for both donor and recipient.

Thus, America's expanding waistlines may be playing a role in the national organ shortage by shrinking the donor pool, the researchers said. Currently, about 92,000 patients are waiting for a kidney, Sachdeva added.

She and colleagues conducted a retrospective analysis of 104 potential living kidney donors seen at their institution between 2008 and 2011. Only 18 percent had a BMI considered to be within the normal range (25 or below), while the majority fell into the overweight-to-obese category: 37 percent had a BMI between 25 and 30, the rest had a BMI of 30 or above.

Almost a quarter (22 percent) of potential donors were excluded from giving up their organs because they had a BMI of 35 or above, the researchers reported. These patients were then referred to a counselor from the institution who creates an individual diet and lifestyle modification plan and follows up with these patients on a monthly basis.

Only three donors (13 percent), however, were able to lose enough weight to donate: "That's not a lot of success, even though the motivation was there," Sachdeva said.

About a third of these patients (30 percent) were unsuccessful at losing weight. The rest declined for medical reasons (9 percent), decided not to donate (26 percent), were lost to follow-up (13 percent), or didn't end up donating for other reasons (9 percent).

Sachdeva said interventions should target the patients who had the motivation to lose weight but couldn't. Clinicians can refer them to an outside weight loss program, or to a gastric banding procedure if they're eligible, she said.

Transplant centers also can implement more rigorous weight reduction programs, with greater follow-up and peer support, she said, adding that more research is needed to figure out which weight loss approaches are most successful.

NKF president Dr. Lynda Szczech said in a statement that the study points out "the impact of obesity as a barrier to donation."

"As the kidney transplant waiting list grows, there is a great need for living donors," Szczech said in the statement. "As a community, we need to identify ways to overcome this barrier so that we can increase our donor pool and end the wait for transplant."

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