Donor "cascades" may make better kidneys available

[okarol]

Donor "cascades" may make better kidneys available
By Gene Emery
Sunday, March 29, 2009

Donation cascades, in which one altruistic donor gives a kidney to a stranger and friends or family of the recipient give kidneys in return, work well and raise donation rates, doctors said on Wednesday.

The practice could add up to 3,000 donors to the system, said Dr. Michael Rees, a transplant surgeon from the Alliance for Paired Donation in Maumee, Ohio, who coordinated the effort.

The system uses people who are willing to donate a kidney to a friend or family member but cannot because they are not a good tissue match. Instead, they give a kidney to a stranger and, in turn, that stranger's friend or family member makes their kidney available to another stranger.

Researchers said the system may make more organs available to the 80,000 people in the United States waiting for them.

Their study in the New England Journal of Medicine suggests that such "extended altruistic-donor chains" are practical and that people who volunteer to donate a kidney carry through on the pledge, even when their loved one gets a new organ first.

About 17,000 kidney transplants are performed in the United States each year, 6,000 with living donors, whose kidneys tend to survive twice as long as those from cadavers.

"I believe we can do an additional 3,000 kidney transplants per year if we can get everybody working together," Rees said in a telephone interview.

Millions of dollars would be saved because 10-year costs for patients who receive a transplant are about $300,000, a half million dollars less than the price of the dialysis needed to keep patients with failed kidneys alive.

In the past, doctors have arranged for simultaneous swaps of kidneys among many different donors and recipients, but the chain system works better because it is more flexible, does not require simultaneous operations, provides a better match and is less likely to cause harm if a potential donor backs out, said Rees.

The new study describes the largest chain to date.

It began in July 2007 when Matthew Jones, then 29, of Petoskey, Michigan, offered his kidney to anyone in need, and continued 10 transplants later when a 60-year-old woman received a kidney in Ohio from the brother of a Maryland man who received his kidney from the friend of another recipient in North Carolina.

Rees said this chain has not been broken, and smaller chains are continuing as well. In addition, 200 people have volunteered to donate a kidney to start new chains. The biggest problem is financing; it costs $3,000 to $5,000 to test kidneys to determine whether they are eligible.

"We used to take an altruistic donor and give it to the person at the top of the waiting list. One person would help one person and that would be the end of it. The cool thing about these chains is that they allow more people to get transplanted," Rees said.

http://www.calgaryherald.com/Health/Donor+cascades+make+better+kidneys+available/1381349/story.html