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Plan lets families trade for kidneys
Thursday, April 12, 2001 By Byron Spice, Science Editor, Post-Gazette
The day may soon come when families who have a loved one in need of an organ transplant had better be willing to give as well as to receive.
In the case of kidney transplants, that day may be at hand.
Brian Broznick, director of the Center for Organ Recovery and Education, said the local organ-procurement agency is establishing a program that would push patients higher up the priority list for a kidney transplant if a family member donates a kidney for someone else.
It's a step CORE has been planning for about eight months and one that is being taken as procurement agencies become desperate to keep pace with the growing demand for transplant organs.
The New England Medical Center in Boston already has launched a version of the program, called Hope Through Sharing, that won approval from the United Network for Organ Sharing in February. That program moves patients up on the waiting list if a loved one donates a kidney to a stranger.
The waiting list for patients who need kidney transplants is approaching 50,000 nationwide, Broznick noted yesterday. That's a level of demand that's impossible to meet by using cadaveric kidneys, he said.
Even if every person who dies would be willing to donate their kidneys, people would continue to die on the waiting list.
The average wait nationally is five years.
"The donor pool, frankly, is shrinking," Broznick said. Better trauma care means fewer young, healthy people are dying from injuries received in car accidents and other mishaps. And the lengthening life span of Americans means many people are too old to donate organs by the time they die.
In addition, procurement officials have despaired to find that some families of organ recipients will later refuse to donate organs of a loved one.
That helps explain why, despite continued efforts to boost organ donation, the number of people who donate organs after death has hovered around 5,000 annually for the past decade, Broznick added.
Living donors have been used since the earliest days of kidney transplantation. But not every person in need of a kidney transplant has a family member who is able to donate and has a compatible blood type.
The Living Organ Donor Registry being launched by CORE is designed to increase the number of living donors by matching them with unrelated recipients.
One scenario, Broznick said, would be a paired exchange. If patient A has a spouse who is willing to donate a kidney but has an incompatible blood type, the program would match the couple with a couple in a similar situation. Patient A's spouse would donate to patient B and vice versa.
If a paired exchange isn't possible, a person might simply donate a kidney into the general pool of organs. In exchange, the donor's loved one would be moved up on the waiting list for a kidney from a deceased person.
Kidneys are apportioned according to a 10-point system based on a patient's tissue compatibility and their waiting time. In the exchange program, two points would be added to a transplant candidate's point total; that would be the equivalent of a year or two of waiting time, Broznick said.
Another scenario of living donation, unheard of only a few years ago, would be people who, out of generosity, donate a kidney to the general pool and receive nothing in return.
Four such potential donors already have identified themselves to CORE, Broznick said. They are now being evaluated psychologically.
Though CORE's living donor program is focused on kidneys, Broznick predicted it eventually will be expanded to other organs. It's possible for people to donate part of a liver, several lobes of the lungs or even half of a pancreas.
Dr. Richard Rohrer, chief of transplant surgery at the England Medical Center, agreed that the exchange program could work with lungs and livers, though those transplants are more complicated, and would raise additional ethical issues.
"Kidneys are primarily distributed by waiting time," he said. "Livers and lungs are distributed based on urgency and there is no dialysis. Figuring out exactly how to give the priority is an issue."
The kidney exchange programs also raise some ethical concerns. But Rohrer emphasized that they don't involve the buying or selling of organs; the only benefit the donor receives for the kidney is another kidney for his or her loved one.
"It is assigning a value to a kidney donation, and the value is exactly a kidney," he said. "On that basis we feel very comfortable."
Dr. Mark D. Fox, medical ethicist at the University of Rochester Medical Center, said while the program gives an advantage to people on the waiting list who know willing donors, everyone benefits in the end.
Providing incentives for living donation is likely to become commonplace across the country, Broznick said.
"The recipient list is just exploding," he said.UNOS' waiting list for all types of transplants is expected to top 80,000 by the end of the year.
Living donors must be at least 18 years old with two healthy kidneys. Potential kidney donors can call CORE at (800) 366-6777.
The Associated Press contributed to this article.
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