Organ Donation: Should Younger Patients Get Better Kidneys?

VIDEO: University of Vermonts Dr. Antonio DiCarlo explains the process.
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Jerry Powell's kidneys may be dying, but the 50-year-old newlywed still has a lot of living to do. Within weeks, Powell will rely on dialysis to filter his blood. And ultimately, he'll need a kidney transplant. But the United Network for Organ Sharing (UNOS) -- the organization charged with allocating the nation's organs -- is considering a policy change that could impact Powell's standing.

Currently, those at the top of an 87,000-strong waiting list are next in line for a matched kidney -- regardless of age and health status.

"We started with what we thought was best at the time, but as things change we need to make improvements," said Dr. Christopher Marsh, chief of transplant surgery at the Scripps Center for Organ and Cell Transplantation and UNOS board member. "The current system is not fair. The new approach, from a medical and scientific standpoint, is an improvement."

The proposed change, which was released as a concept document Feb. 16 for public comment, would reserve 20 percent of donor organs for those receipients expected to live the longest after a transplant, and the remaining 80 percent for recipients age-matched to within 15 years of the donor.

"This would reduce the possibility that a candidate reasonably expected to live ten more years receives a kidney that may function for 40 years, or conversely that a candidate reasonably expected to live 40 more years receives a kidney that may function for only ten," Anne Paschke a spokeswoman for UNOS, said in a statement.

Only 17,000 Americans receive a transplant each year, and more than 4,600 die waiting.

"When faced with the prospect of rationing, the ethical responsibility is to use resources prudently and save the most lives and years of life," said Arthur Caplan, chair of medical ethics at the University of Pennsylvania. "It's the policy we follow during war: help those most likely to recover without doctors and intensive care beds. The sicker you are, the less likely you are to do well with a transplant."

Need for Change

Although the proposal was only recently made public, the idea has been around for almost a decade.

"It's been a long process," Marsh said. "We've come up with ideas and run up against barriers. Change is difficult, and patients and programs are used to a simple allocation system."

"Every policy change is always disconcerting because there are new winners and new losers," said Dr. Antonio Di Carlo, assistant professor at the University of Vermont College of Medicine and chief of transplant surgery at Fletcher Allen Healthcare.

According to the 40-page proposal, people over 50 would lose an advantage they currently hold. The donor pool for a 60-year-old could theoretically be cut by half.

"No matter how you look at it, there will be some people advantaged fairly and disadvantaged unfairly. But the same thing goes with the current policy. It's not right to have someone die with a pristine kidney while a young person needs two or three transplants throughout their lifetime."

For patients like Powell, the change could mean getting an older kidney with fewer functional years. It could also mean getting an "extended criteria donation" -- a kidney that, until recent years, would not have been transplanted at all.

"I think it my particular case, it would limit my options," Powell said.

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