Organ Donation: Should Younger Patients Get Better Kidneys?
Amid shortages, transplant surgeons and ethicists rethink who should get dibs.
Feb. 25, 2011— -- 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."
