Old kidneys for old folk in transplant plan

Old kidneys for old folk in transplant plan
JULIE ROBOTHAM HEALTH EDITOR
October 19, 2009

THEY are the kidneys transplant doctors reject: considered too old or unhealthy to give another person a decent shot at life.

Now, they may be harvested after death from people in their late 60s or 70s to ease Australia's desperate shortage of organs for transplantation, but only if the recipient is also elderly – under a proposal about to unleash an ethical storm.

"People have been hesitant to recommend the approach in case it's seen to be discriminatory" in denying people access to the healthiest organs because of their age, said Peter Macdonald, president-elect of the Transplantation Society of Australia and New Zealand.

Transplants were usually carried out in the expectation the graft would last 13 to 15 years, Professor Macdonald said.

"But an older person may be very happy with a transplant that has a good chance of giving them five to 10 years of good quality life."

The fraught issue has emerged in a Federal Government discussion paper as experts begin a national revision of organ allocation policy, amid a growing gap between availability and need.

"It is anticipated that the medical quality of donated kidneys will continue to fall, as more kidneys are received from older donors," the paper says. "Consideration will be given to whether these should be allocated in a different way." New rules could apply to "approximately the worst 10 per cent of kidneys".

People aged 70 or older are not accepted for transplants from deceased donors, and those in their late 60s rarely reach the top of the waiting list – which comprises about 1300 of the 10,000 Australians on dialysis.

Last year 459 Australians were given kidney transplants from deceased donors – typically previously healthy people in their 40s who die suddenly from a stroke.

Jonathan Ehrlich, a renal physician at Prince of Wales Hospital, said: "Rather than talking about the life of the kidney per se, you've got to think about what sort of function it would provide for an individual.

"It may still be beneficial for [older] people because their outlook on dialysis isn't good . . . anything that's going to improve in general the supply of organs has to be a good thing."

Dr Ehrlich said doctors had absolute discretion to accept or refuse any kidneys that became available to their patients, so covert age discrimination was already possible.

"What a [doctor] bases that decision on, it's almost impossible to say," he said.

Tim Mathew, medical director of the advocacy group Kidney Health Australia, said the community should debate the question, which pitted "utility versus equity". Extracting the maximum functioning time from a donated kidney – which favoured younger, healthier recipients – had to be balanced against fair access to medical treatment for everyone, he said.

After dialysis three times a week for three years, Barry Mathers, 69, had given up hope of a new kidney when he got the call last year. He believes a policy change might be beneficial if it raised the chance of a transplant for others his age. "Even for five or six years, just to get away from dialysis for that time is a big thing," said Mr Mathers, who now swims daily near his home in Maroubra.

Mr Mathers was told by the doctor who assessed his fitness for the operation that he could live to his mid-80s. His donated kidney from a younger person, "could last 15, 16 years," he said. "It's a good run."

http://www.smh.com.au/national/old-kidneys-for-old-folk-in-transplant-plan-20091018-h2zo.html