Older healthy donors should be allowed: Doctor

Older healthy donors should be allowed: Doctor

Thu, Nov 06, 2008

The New Paper

MORE living donors above the age of 60 should be considered if they are found to be medically and psychologically suitable for surgery to donate their kidneys.

Dr Terence Kee, consultant transplant physician at the Singapore General Hospital's Kidney Transplant Programme, said that scientific evidence suggests that they are not at higher risk of surgical complications compared with younger donors.

This is because they have to be completely healthy to be a donor, he said in an interview with The New Paper.

Centres in the west have reported data on transplants that are performed using kidneys from older living kidney donors.

The age range of the older donors is from 55 to 81 years (with an average age of about 65).

The kidneys are given to younger recipients, ranging from 30 to 60 years of age (with an average age of about 35 years).

Said Dr Kee: 'These centres report that the survival of these transplant patients for up to five years appears to be the same as that of patients who had younger living kidney donors.'

Living kidney donor transplantation is the better option to treat end-stage kidney failure for patients who are suitable for a transplant.

Not only does transplantation potentially restore normal body functions completely, it can reduce the increased risks of death associated with dialysis.

In contrast, patients on dialysis have a poorer survival rate.

Among the reasons for this is that many are older, with multiple medical conditions that make them very sick.

They may also develop complications related to long-standing kidney failure.

Thus, living kidney donor transplantation should be done before the start of dialysis whenever possible, said Dr Kee.

This is called pre-emptive kidney transplantation, he said.

'Indeed, 19 per cent of all our living kidney donor transplants done in SGH since 2005 have been pre-emptive kidney transplants,' he said.

Pre-emptive transplants encouraged

'We encourage patients to consider pre-emptive kidney transplants when the time is right, such as when the kidney failure is progressive, irreversible and has reached a certain level over the past 12 months of review.'

Scientific evidence suggests that the outcomes are better when they are done before the start of dialysis.

For living donors, tests to determine suitability takes less than three months.

Said Dr Kee: 'For older donors, they need more extensive checks on their heart and to check that there is no risk of cancer or any other conditions that may put them at excessive risk during surgery or after donation.'

All donors are followed up for life after surgery at the SGH living kidney donor clinic.

'We encourage them to stay healthy and come for our clinic review on an annual basis,' he said.

This story was first published in The New Paper on Nov 4, 2008.

http://health.asiaone.com/Health/News/Story/A1Story20081106-98618.html