http://www.sfgate.com/health/article/New-rules-for-kidney-allocations-5164066.phpNew rules for kidney allocations
Victoria Colliver
When it comes to kidney transplants, it will soon no longer be first come, first served.
New rules, which go into place this year, will change the way kidneys from deceased donors are allocated across the country and hopefully balance out wait times for those who need one and improve their long-term survival.
Currently, a young kidney might go to someone with a very short life expectancy. If a kidney is found for someone who has antibodies that make finding a match extremely difficult, it may not matter. Someone else higher on the list will get the kidney, even someone without those complicating factors.
Someone in need of a transplant may get a kidney sooner or later, depending on the region where the patient lives.
"Right now it's just a hodgepodge," said Dr. William Bry, surgical director of the kidney transplant program at California Pacific Medical Center in San Francisco. "There's nothing to prevent a perfect kidney from a 16-year-old from going into a 78-year-old person with diabetes and heart disease."
Available kidneys for transplant are scarce, but the current rules put too much emphasis on the amount of time a patient has spent on the waiting list, said Bry, who served on a committee that helped develop the new criteria.
"There's certainly an ethical argument for the person waiting the longest to have their shot next," he said. "But in terms of limited resource, it makes more sense to get as many years out of that limited resource that we can."
Thousands waiting
More than 96,000 people in the United States are waiting for kidney transplants, and about 10 percent of them are expected to die as they wait.
The region that includes the Bay Area has among the longest wait times for kidneys in the United States - five to seven years, according to the California transplant Donor Network, which manages organ and tissue donation in Northern California - excluding the Sacramento area - and parts of Nevada. Regions diverse in race and ethnicities tend to have longer wait times.
It's been a decade since the federal government directed the United Network for Organ Sharing, the agency that oversees the transplant network nationwide, to make the changes.
Certain factors make kidney donation and transplantation different from that of any other organ. For example, dialysis, an artificial process that replaces some kidney functions such as waste removal and fluid removal, has been available to kidney patients for decades.
"So the sense of urgency was never there," Bry said. "Dialysis may not be a great option, but it can keep you alive."
The donors
A kidney transplant patient can also receive an organ from a living donor if they're fortunate enough to have a match. Unlike most other transplantable organs, people have two kidneys and can get by on one.
Still, the vast majority of transplanted kidneys come from deceased organ donors, and there just aren't enough to go around.
"We're trying to make a system that does not alter the priority people already have, but provides better benefit for the people who need it most," said Joel Newman, spokesman for the United Network for Organ Sharing.
One the bigger changes involves better matching the life expectancies of patients with the age and quality of the donated kidney.
Kidneys will still be available to older patients, but the change is designed to give younger patients the organs that are expected to last the longest.
Dr. Peter Stock, a transplant surgeon at UCSF and former chairman of the kidney committee that developed the new rules, said that change will affect just the 20 percent of patients with the longest life expectancies. "The other 80 percent are going to be allocated pretty much as they were before," he said.
The new allocation will also help reduce regional differences in wait times. For one, kidneys that are not expected to function for a relatively long time will be made more widely available.
The idea is to reduce the chance that a less desirable kidney might go unused if it doesn't match a patient high on the waiting list somewhere else. The revised rule would allow a patient who lives within the region the organ has become available an opportunity to get it.
Some patients have biological differences - such as rare blood types or antibodies - that make them harder to match. Under the new system, those patients would receive higher priority so they have a better chance of finding a match.
On the list sooner
Another key change will create a common starting time for those waiting for a transplant. Under the current system, people are placed on the list only after they are evaluated and accepted as transplant patients. The new system starts the clock the day a patient begins dialysis.
That change will likely help Jonathan Mack, 40, of Oakland, who started dialysis in 2008, a full year before he was officially placed on the waiting list.
Mack shattered his kidney in a running accident when he was 13, and his remaining kidney started to falter in 2007. The single father of a 6-year-old girl said he's thrilled about any changes that would move him up on the waiting list.
"Whenever they call, I'll be there in a heartbeat," said Mack, who undergoes dialysis three times a week for over four hours a session.
As a younger patient, Anna Mae Olivares, 31, of Sunnyvale, knows she will also likely benefit from the new rules.
Her kidneys started to fail five years ago because of an autoimmune disorder when she was a medical resident in the Philippines. Olivares, who is also on dialysis, was forced to end her residency and has been unable to work since moving to the United States with her husband two years ago.
But Olivares is uncomfortable knowing any advantage she could receive will affect others. She's aware that anytime one person moves up on the waiting list, another is bumped down.
"Of course I want to have a transplant, but I don't want to get that opportunity from another individual who's been on the list longer," she said.
Kidney donation changes
The federal government directed the United Network for Organ Sharing, the agency that manages organ donation in this country, to change the rules affecting the allocation of kidneys from deceased donors. Here are some of the more significant changes to the policy, which was approved last year and is expected to go into effect by the end of this year:
Life-expectancy matching: The new rules will match the best kidneys with the top 20 percent of people with the longest life expectancy. This is expected to benefit younger, healthier patients.
New start time for waiting: The clock for a new kidney will start the day patients start dialysis, not just when they are evaluated and put on the formal waiting list.
Reduced waste: Kidneys with lower functioning will be offered in a wider geographical region. This is designed to give more people more access to organs and reduce the likelihood that a less-desirable kidney in a region will go to waste.
Greater access for disadvantaged patients: The revised policy will improve transplantation opportunities for people with biological disadvantages such as less common blood types and antibodies that cause immune sensitivity.
Topic: New rules for kidney allocations (Read 3254 times)