Living Kidney Donation Declining in U.S.

[Karol]

Jody A. Charnow
May 21, 2013
Living Kidney Donation Declining in U.S.

SEATTLE—Living kidney donation has steadily decreased since the peak year of 2004, researchers reported at the 2013 American Transplant Congress.

The downward trend is most pronounced among men, blacks, younger and lower-income adults, siblings, and parents.

After an analysis of data from the Organ Procurement and Transplantation Network (OPTN), James R. Rodrigue, PhD, of the Center for Transplant Outcomes & Quality Improvement at The Transplant Institute, Beth Israel Deaconess Medical Center in Boston, and colleagues concluded that “there is considerable downward pressure” on living donation rates despite novel programs to help patients find a suitable living donor, national financial programs and state tax incentives, and heightened general public awareness of living donation.

OPTN data show that the number of living donors increased from 1,817 in 1988 to 6,647 in 2004, and then declined to 6,572 in 2005. In 2012, 5,618 living donations took place.

For the study, Dr. Rodrigue's team compared two eras: 1998-2004 (era 1) and 2005-2011 (era 2). From era 1 to era 2, the proportion of living donors who were male declined from 41.9% to 39.8% and the proportion of living donors who were black declined from 13.4% to 12.2%.

According to the authors, financial disincentives during an economic slump may be one contributing factor to the downward trend in living donation. Potential living donors may have greater concern about employment security or stability during a recession and less willingness to absorb lost wages, which could happen if donate.

The changing health status of the U.S. general population is another possible reason, the researchers noted. They pointed out that the proportion of adults with diabetes and adults who are obese has increased and hypertension is “alarmingly prevalent.

“Collectively,” they wrote in a poster presentation, “these risk factors increasingly are the most common reasons for [living donation] exclusion, particularly among minorities.”

Another reason for the decline in living donation could be increased emphasis on transplant center performance oversight, Dr. Rodrigue and his colleagues stated. Such oversight might lead to more conservative policies and practices due to potential impact on center performance reports.

They cited a recent report by Jesse Schold, MD, and colleagues in the American Journal of Transplantation (2013;13:67-75) showing that transplant programs receiving a low performance evaluation had an average net decrease of 15 living donor kidney transplants compared with an average decrease of only three LDKTs among centers that did not have a low performance evaluation.

http://www.renalandurologynews.com/living-kidney-donation-declining-in-us/article/294166/

[Dirty Rocker]

This is so depressing. For me, there was no doubt in my mind once I knew the risks, but I still ran across many people that said they didn't think they could do it. I realize it's a huge 'sacrifice' (I use that word loosely because I don't feel like I have sacrificed a darn thing!) It is so sad to me that there are not more brave, kind people that are aware of the (mostly minimal) risks associated with donation.

[brenda]

I too had little or no reservations prior to donation. Now I see these articles and think, "If it is so benign, why don't more physicians donate organs?"  MD's are well represented (over represented) as blood donors, but very few are living donors - and even smaller percentages of transplant surgeons and nephrologists turn up in my cursory review of blogs and published donor stories (like 1). Why don't these men and women volunteer to help the patients that must tug at their hearts?

I'm only partially being sarcastic. I do think that if the transplant physicians as a group donated, it would be a tremendous media event and generate more "lay" donors.

Brenda

[Dirty Rocker]

Brenda, I agree with the sentiment, but I can't help but have sympathy for the doctors that must see so many stories of struggle that tug at those heart strings. I think that the fact that you can donate blood many times vs once for a kidney donation really plays a factor. I'm sure there must be doctors that have donated for family members or close friends, but I imagine that first hand knowledge of the difficulties that people face during organ failure play a significant role in that decision-- they must think, what if a family member needs my organ and I can't give them one because I've already donated to someone?

Just my two cents...

[sherri]

Brenda,

I also asked the same question when being evaluated as a donor. Unlike you, I was very “not on board” with having an elective surgery. I worked in a hospital so I maybe I knew too much. I distinctly remember the doctors and nurses explaining how easy and minimally invasive the surgery was after I kept bringing up all the risks involved. I looked at them and said, “you all have two kidneys”. There wasn’t much to say after that.  I believe the reason that more doctors, and in particular surgeons, do not donate is because they know what happens in hospitals. For a family member some of the health care providers might step up, but for a stranger, not so much. Everyone expects family and friends to do it not innocent bystanders. There is an underlying expectation that family will either want to do this or is expected to step up to the plate. Doctors know the complications of just being hospitalized, whether it is from medication errors, infection, blood clots, etc and know that surgery has real risks. It’s always easy to quote the 2 – 3 deaths in 10,000 (as Dr. Satel quotes in her article) but when it happens to you it’s 100%. Would be interested in knowing how many health providers have agreed to become organ donors upon death.


http://www.nytimes.com/2007/12/16/magazine/16kidney-t.html?pagewanted=all&_r=0

Desperately Seeking a Kidney by Sally Satel  12/16/07

Dr. Satel, a psychiatrist writes about her ordeal in trying to find a donor. In her article she described an encounter with a potential donor, a colleague, also a doctor. See the excerpt below.

 “…I told one of my best friends about my diagnosis. She and I first met more than 20 years before at the medical school at Yale, when I was finishing my residency in psychiatry and she was an instructor in the same department. Dr. Yale, as I’ll refer to her to protect her privacy, is a feisty blend of bubbly energy (last summer she made me ride the Cyclone with her at Coney Island) and intellectual seriousness (she is training to be a psychoanalyst). She immediately offered to check her blood type. I needed someone with type A or O, and in uncomplicated cases like mine, blood-type matching is usually one of the biggest hurdles to compatibility. Dr. Yale was type O. Presto!
She said she needed to talk it over with her husband but thought it would be fine. A week later, however, she said it wasn’t. “Giving you a kidney seemed a perfectly natural thing to do,” she told me. “I had the time, and I wanted to do what I could and in a clear way, far clearer than the vague helpfulness of say, psychiatry. But then I mentioned my plan to donate to a fellow alto at chorus rehearsal one evening.” As it turned out, the alto in question was no typical acquaintance: she was a transplant surgeon. My friend continued: “She was very surprised that I was planning to donate to a friend and then pulled an article out of her bag about hemorrhaging after donating.” The exchange set off a spiral ofanxiety in Dr. Yale’s mind — What if my brother or kids need my kidney? What if I had complications from surgery? I’m sorry, she said matter-of-factly, and that was that.
I understood that my friend wanted to spend her kidney wisely. What mystifies me still is how she got so spooked. After all, Dr. Yale was a physician herself, capable of weighing the risks. The operation is done by laparoscope, leaving only a modest three-inch scar; she would have been out of the hospital after two or three nights. Most important, the chance of death is tiny — 2 in every 10,000 transplants — and the long-term health risks are generally negligible.
More baffling to me, though, was the fact that she was talked out of donating by a person who removes and implants organs for a living. I was outraged. A transplant surgeon, of all people, knows how hard it is to find a donor, how grueling dialysis can be and how significant the health benefits of a “pre-emptive” transplant (that is, one received before the patient goes on dialysis) are. Not to mention the fact that hemorrhaging after donation is unusual. How dare she discourage someone who was ready to donate! Or had my friend been ready? It doesn’t matter now. But at the time, the surgeon was such a ready scapegoat that I could push the uneasy question about Dr. Yale aside.”