New rules give hope to people waiting for donated kidneys

[Clark]

http://www.ksl.com/index.php?sid=32626322&nid=157&title=new-rules-give-hope-to-people-waiting-for-donated-kidneys

New rules give hope to people waiting for donated kidneys
By Jen Christensen

Chardae Sanders received some potentially good news this week from the organization that decides who gets donated kidneys.

Sanders, 28, has been on dialysis for about six years. Lupus, high blood pressure and an infection caused a kidney to fail. The Georgian already received one kidney from a living donor in 2009, but her body rejected it the next year due to a parasite. Working through Emory University Hospital, she's been waiting for a donated organ ever since. "They said they will call when there's a match," Sanders said.

Effective Thursday, changes in the way the waiting list is calculated could work in her favor, including the length of time she's been on dialysis, her young age and a couple of other factors. There's hope that call from Emory may come sooner.

Kidneys are a scarce resource. Fewer than 17,000 transplants are performed a year, and there are 101,954 people who need a donated kidney, according to the United Network for Organ Sharing, or UNOS, the organization that runs the system.

When someone needs a transplant, he or she is placed on a waiting list. Where someone falls on that list depends on a wide variety of factors. These shifted with Thursday's changes. The hope is that the new criteria will help maximize the benefits from the small pool of donated kidneys available.

Before the changes, people who were waiting the longest would be higher up on the list. Now the healthiest of the kidneys will be offered first to patients whom doctors expect will survive the transplant the longest. The viability of transplant is determined by the age of the kidney and the kidney donor's medical history.

Dan Webb was already prepared to donate a kidney when he saw a plea on Facebook from a man in Virginia asking for help.
Of transplant candidates, almost 15 percent are waiting for a second transplant because their bodies rejected the first.

Tonya Saffer, senior health policy director at the National Kidney Foundation, explains: "If you give a 20-year-old a 65-year-old kidney, there is a likelihood the 20-year-old will have to get another transplant at some point. So this fixes that," Saffer said. "We will be able to make better use of kidneys and not have to re-transplant as many people,"

Reducing those transplants means the number of people waiting for kidneys should then go down.

Other revisions include a shift that helps people who are tough to match because they have higher levels of antibodies that make them not the best candidate for transplantation. They move up on the waiting list.

Minority patients who typically have a blood type of B should benefit from a change in the policy. The policy widens the pool of blood types that would be a match for that person.

The number of years people have been on dialysis will now count toward their time on the waiting list. But the less time someone spends on dialysis the better the chance the transplant will take.

The change in dialysis rules should also help minority patients since studies show as a group minorities and people in rural areas tend to spend more time on dialysis.

There will also be a priority given to living donors. If you gave someone else a kidney and you need one down the road, you will automatically start higher up on the list.

The changes are a big shift, according to Saffer.

"It's a big deal. I think it is definitely an improvement over what the policy is today," Saffer said. "No policy is ever going to be completely fair for everyone because there aren't enough kidneys for everyone who needs one, but this is a step in the right direction to make sure we are reducing organ wastage and trying to increase the number of people getting kidneys."

[Clark]

http://tucson.com/lifestyles/health-med-fit/new-national-system-for-donor-kidneys-to-affect-local-transplants/

New national system for donor kidneys to affect local transplants
By Stephanie Innes

A new national system for allocating kidneys is expected to soon end Tucson resident Anna Sherry’s long wait for a transplant.

"This is going to be a good year for me," Sherry said of 2015.

The revised policies aim to improve access for specific groups of patients like Sherry, whose high level of antibodies makes her more difficult to match.

Overall the new system aims to better match organs to recipients by matching the likely length of time the donor kidney will function with the expected length of time an adult candidate may need a kidney transplant.

More than 100,000 Americans are on the national waiting list, and the need for kidney transplants is increasingly outpacing available kidneys available from deceased donors.

Nearly 240 people are on the waiting list at the University of Arizona Medical Center, which will host free information meetings this week and next about the change.

The meetings are scheduled for 5 p.m. Thursday and at the same time Dec. 17 in DuVal Auditorium at the UA Medical Center, 1501 N. Campbell Ave.

Members of the UA Medical Center transplant team, as well as community nephrologists, will be available to answer questions about the new allocation system.To register, call the UA Medical Center Transplant Office at 694-7365.

Ideally the new system will decrease the number of people needing second and third kidney transplants, and also help a certain small group of patients, including Sherry, to have a shorter wait time.

Sherry, 54, was first placed on a waiting list for a kidney in 2009. The average wait for a kidney from a deceased donor is currently three years and two months, and people who are difficult to match typically wait longer.

The updated system gives increased priority to candidates like Sherry whose immune systems are not compatible with most donor kidneys. And revisions to blood-type matching under the new system are expected to provide more opportunities to candidates with more rare types.

The changes took effect Friday and are the result of about 10 years of work by the United Network for Organ Sharing (UNOS), said Dr. Pradeep V. Kadambi, medical director of solid organ transplantation and a nephrologist at the UA Medical Center.

UNOS is responsible for matching kidneys and other organs from deceased donors with patients on the waiting list.

“The current system had many limitations, with a high discard rate of donor kidneys that could have benefited candidates on the waiting list,” Kadambi said.

Candidates who were listed for a kidney transplant prior to the implementation of the new system will not lose any priority on the waiting list, and the great majority of kidney matches will continue to take place under policies that have been in place for a number of years, UNOS officials say.

Under the new system, each kidney transplant candidate will receive a score estimating how long he or she will need a kidney transplant relative to the others listed for a kidney transplant.

Each donor kidney also will receive a score predicting how long the kidney is likely to function compared to other kidneys. The 20 percent of kidneys that have the longest expected function will be offered first to the 20 percent of candidates who will need a kidney for the longest time.

Many factors go into the matching process, including blood and tissue type, body size, distance from the donor hospital to the transplant candidate’s hospital and the time a candidate has spent on the waiting list.

Kadambi stressed that the best option for a successful kidney transplant with optimal longevity is by using a living donor.

“It’s a scheduled operation with usually no surprises and good quality kidneys,” Kadambi said.

The UA Medical Center has done 24 kidney transplants to date this year, all from deceased donors. Nationally about 16,000 kidney transplants are performed each year.

The new changes will not affect pediatric kidney transplants — those patients will remain high priority.

About 2,000 Arizonans are waiting for a kidney transplant, UNOS says. Donor Network of Arizona spokeswoman Jacqueline Keidel says her organization continues to focus on registering more people as donors.

[Clark]

http://www.startribune.com/lifestyle/health/284430081.html

HEALTHBEAT: Rules taking effect this week change how some people are matched to donated kidney
Article by: LAURAN NEERGAARD

New rules this week are bringing changes to the nation's kidney transplant system that will give some patients a better shot at a longer-lasting organ, and move others up the waiting list.

The goal is to get the maximum benefit out of a scarce resource: kidneys from deceased donors.

"Not everyone's going to get the same benefit out of a kidney transplant," said Dr. Matthew J. Ellis of Duke University Medical Center, who is optimistic the new policy will help. "We're trying to apply commonsense principles to address those issues."

The long-awaited changes from the United Network for Organ Sharing, or UNOS, come as the gap between who needs a new kidney and who gets one widens. Nearly 102,000 people are on the national waiting list for a kidney, while fewer than 17,000 transplants are performed each year.


Roughly 11,000 transplants are thanks to kidneys donated from someone who just died rather than living donors. How long you've been waiting is the main factor in deciding who gets the next available cadaver kidney.

But starting Thursday, the fittest of those kidneys — based on donor age and medical history — will be offered first to patients who are expected to survive a transplant the longest.

Called longevity matching, the hope is that these typically younger adults won't outlive their new organ and need another that could have gone to someone else.

Nearly 15 percent of transplant candidates are awaiting a repeat operation, and "the potential here is that we will reduce return to the waiting list," said Dr. Richard N. Formica of Yale University, who chairs UNOS' kidney transplant committee.

Another big change: People who started dialysis before getting in line for a transplant will be credited for that dialysis time, moving them up on the waiting list.

The less time spent on dialysis, the better the prognosis after a transplant. Yet how quickly people are put on the transplant list varies around the country, and minorities and people who live in rural and poorer areas tend to spend more time on dialysis.


Michael Brown, 31, of Cleveland has undergone dialysis since he was 20 because of an inherited disorder. But he wasn't put on the transplant list until three years ago, when he saw a new doctor who told him, "You need to be active, and you shouldn't be tied to a machine."

Brown said he hadn't pushed to be listed sooner partly because of fear, and partly because no one had fully explained the benefits of an earlier transplant. He got in shape for a transplant, and was excited to learn he'll get credit for those years on dialysis.

"It is definitely a blessing," Brown said. Receiving an organ "will be an incredible gift that I could never repay."

Recalculating waiting lists and estimating patients' life expectancy has been a big job for transplant centers.

"We're scrambling to get this done," said Dr. John Roberts, transplant chief at the University of California, San Francisco, one of the nation's largest kidney programs.

But he called the changes necessary to begin dealing with rapid growth in transplant demand, mostly by people over age 50, which in turn has lengthened wait times. In parts of the country, the wait can average five years. Last year, 4,485 people died waiting.

Children already get priority for transplants. Among the changes for adults:

—The longevity matching would pair the kidneys expected to last the longest with the 20 percent of patients predicted to have the longest post-transplant survival. Every candidate will receive a score based on their age, length of dialysis, if they're diabetic and if they've had a previous transplant of any organ.

—On the other end, the 15 percent of kidneys expected to last the shortest amount of time will be offered first to a wider area of the country than other kidneys. The idea is that someone expected to live only a few more years anyway might prefer a quicker transplant rather than staying on dialysis in hopes a better kidney comes along.

—The system also will give extra priority to people who are particularly hard to match because of blood type or because their immune systems are abnormally primed to attack a new organ.

The changes can't address the need for more organ donors, noted Duke's Ellis. Because some regions have more donors than others and organs are offered locally first, his team encourages patients to consider getting on waiting lists at more than one transplant center.

And try asking relatives or friends if they'd consider giving a kidney: "The best way is to bring a living donor to the table," he advised.