Under kidney transplant proposal, younger patients would get the best organs

[Jie]

Going through the proposal,I think many posts in this topic missed an important point under this proposal. The proposal has two major features: (1) youth patients get better kidneys and (2) waiting times decrease greatly with youth patients and increase greatly for old patients. Sure, there is no age cutoff. But if you are 60 years old and your waiting time increases from current 5 years to more than 10 years, you are effectively cutoff from receiving any kidneys. Under the proposal, anyone older than 50 will see the waiting time increase. Worse, for old patients, longer you wait, less kidneys are available to you and you have to wait even longer. Even patients older than 45 could be affected because you need to add waiting time to your age to see how many kidneys are available to you. The -15 years and +15 years does not adequately address the fairness issue. It may need -5 years to +25 or +30 years to make waiting times not much dependent on age. The proposal hid the second feature.

Here are the donor ages and patient ages:
Age              Donors (%)     Waiting list (%)
 1-17 Years                    16.51            0.84
 18-34 Years      29.46   10.20
 35-49 Years   25.60   27.36
 50-64 Years   22.33   43.07
 65 +                       6.10   18.52
50+                     28.43   61.59
Total persons   7248   93637

[Sugarlump]

Interesting and poignant fact that 61.5 % of the waiting list are 50 years plus and this is the category that will feel the effect of the changes most.
Don't get old ...

[MooseMom]

I'm not sure your conclusions are accurate, Jie.  As our population ages, there would probably be more organs available for older patients, actually. 

Page 32 of the proposal is interesting as that's where it addresses how to increase the number of organs that can be transplanted.  It points out that some transplant centers discard EC kidneys because they don't want their success rate evaluation to be adversely affected, thus reducing their CMS reimbursement.  The Committee looked at data compiled by the Eurotransplant Senior Programme and found that they discarded significantly fewer kidneys, and this proposal could incorporate some of those ideas to enlarge the donor pool.  THAT's at the center of the solution...don't just reallocate but also allow for more kidneys to be available.

Of course, if the US would implement an opt-out program, that would help.  The allocation proposal assumes that there are no changes in donation policy.  If there WERE to be such a change, then this whole proposal might become irrelevant.

[Jie]

Actually, the proposal mentions that old patients increased sharply over time. If the trend continues, the impacts on old patients are worse than my conclusions. The auto accidents involve youth persons a lot  more than the old persons.  One study is needed to examine the median waiting times for different age groups under the proposal.  It seems the committee does not want the public to know the changes in waiting times for different age groups under the proposal. I found some quotes of the committee members in some reports are misleading in term of opportunity of kidneys available to old patients, such as this:

"Dr. John Friedewald of the Northwestern University School of Medicine, who is vice chairman of UNOS's Kidney Transplantation Committee, said the organizations had been working for more than six years to make sure the concept wouldn't reduce anyone's opportunity to receive a kidney, including an older or sicker patient."

It does not take much education to figure out the impacts on old patients by looking at the donor ages and patient ages. Dr. Friedewald should know better than giving out such a misleading statement!

Whether the discarded EC kidneys can make up the difference is still a big question mark. There is always a reason for a kidney to be discarded. By memory, about 90% of kidneys are used in my area.

[okarol]

Here's a follow up interview with guests on NPR http://ihatedialysis.com/forum/index.php?topic=22178.0