Kidney donation is safe over 70

[Clark]

http://www.barchester.com/Healthcare-News/Kidney-donation-is-safe-over-70/376/4909

Kidney donation is safe over 70

Healthy individuals over the age of 70 can safely donate a kidney.
People over 70 can still donate a kidney, according to a recent study.

Researchers in Washington have discovered that healthy individuals over 70 years old were no more likely to die within one, five or ten years after donating than healthy older adults who were not organ donors.

The findings are good news for those patients with limited donor options in need of a kidney.

Dr Dorry Segev, investigator on the study, stated: "It is important for individuals over 70 who want to donate a kidney to be aware that many have done so safely.

"Many older adults - and even many physicians - are not even aware that this occurs."

Studies are increasingly proving that kidney donors are at very little medical risk and that, in the long term, people who donate one of their kidney's are likely to live just as long as those who have two healthy ones.

Dr Segev discovered after looking at data from a national registry of 80,347 live kidney donors in the US that there were only 25 deaths in the first 90 days after donation surgery over a 15 year period.

[sherri]

Dr Segev discovered after looking at data from a national registry of 80,347 live kidney donors in the US that there were only 25 deaths in the first 90 days after donation surgery over a 15 year period.


Maybe I am responding from the heart instead of the head but reading "there were only 25 deaths in the first 90 days after donation surgery over a 15 year period" does not sound like a statistic I would not care to be part of. Donation surgery is elective surgery. So these 25 patients (someone's mother, father, sibling, child, friend) did not need this surgery at all. They had 0% chance of any adverse effect to their health unlike sick patients who take the risk of surgery in order to improve their health. So what might be an acceptable mortality statistic for a sick patient might not be equivalent for a healthy patient who did not need surgery.  Kidney recipients, unlike liver or heart recipients do have a mechanism to stay alive, albeit on dialysis. Yes, dialysis does have detrimental effects but in essence is life saving or life prolonging. Also what happened after 90 days and how many living donors suffer long term health complications or death and was not reported. Recently, there has been a lot of controversy surrounding mammograms and if screening actually saves lives. If your life was saved then it was worth it to you and your family. How are the recipients whose donors died as a result of them having an elective surgery doing and would they feel that it was worth the risk.

[Karol]

The donors "elected" to undergo surgery to save a life.
Dialysis is life support. It's a slow death.

[Clark]

http://www.ncbi.nlm.nih.gov/pubmed/22034505

Living Kidney Donors Ages 70 and Older: Recipient and Donor Outcomes.
Berger JC, Muzaale AD, James N, Hoque M, Wang JM, Montgomery RA, Massie AB, Hall EC, Segev DL.
Clin J Am Soc Nephrol. 2011 Oct 27. [Epub ahead of print]

Abstract
Summary
Background and objectives
The profound organ shortage has resulted in longer waiting times and increased mortality for those awaiting kidney transplantation. Consequently, patients are turning to older living donors. It is unclear if an upper age limit for donation should exist, both in terms of recipient and donor outcomes.Design, setting, participants, & measurements In the United States, 219 healthy adults aged ≥70 have donated kidneys at 80 of 279 transplant centers. Competing risks models with matched controls were used to study the independent association between older donor age and allograft survival, accounting for the competing risk of recipient mortality as well as other transplant factors.Results Among recipients of older live donor allografts, graft loss was significantly higher than matched 50-to 59-year-old live donor allografts (subhazard ratio [SHR] 1.62, 95% confidence interval [CI] 1.16 to 2.28, P = 0.005) but similar to matched nonextended criteria 50-to 59-year-old deceased donor allografts (SHR 1.19, 95% CI 0.87 to 1.63, P = 0.3). Mortality among living kidney donors aged ≥70 was no higher than healthy matched controls drawn from the NHANES-III cohort; in fact, mortality was lower, probably reflecting higher selectivity among older live donors than could be captured in National Health and Nutrition Examination Survey III (NHANES-III; HR 0.37, 95% CI 0.21 to 0.65, P < 0.001).Conclusions These findings support living donation among older adults but highlight the advantages of finding a younger donor, particularly for younger recipients.
PMID: 22034505

[lawphi]

So much depends on the relationship with the recipient and the donor's cost benefit analysis of the situation.   I more than likely would be a widow without children in five years had my husband not lucked into his kidney. 

The lawyer in me wants to break down the awful deaths by center and the number of living donor surgeries performed.

It is ok to speak from the heart. This is a major decision and should be questioned at all angles. Donation is not right for everyone, but perfect for others.

[Donna Luebke]

Sherri--glad you pointed out the mortality data.  25 is a lot of people but note how this number doubled if went out 6 months!!  Segev did not say that all these deaths were via the laparoscopic approach although hinted at higher % during the earling learning curve perido.  Wonder if any of those who died knew they were in a learning curve??  This mortality data is not all-inclusive since UNOS never used a system to verify that had the correct SS#--and there are well-known flaws in the Social Security Master Death Index.  Plus--if a non-citizen, there is no SS# to track donor outcomes via Social Security Data.

My word of caution is that we consider ways to make living donation 'safer' and stop saying is 'safe.'  No surgery is safe.  Anesthesia for anyone over 70 is even less safe.