New kidney donation system could change who gets the best organs

[justme15]

http://news.yahoo.com/kidney-donation-system-could-change-gets-best-organs-154846916.html?_esi=1


The way that donated kidneys are allocated to patients needing transplants might be changed in the next few years, so that the fittest organs would be given to those likely to live the longest with the donated organ.
That was the announcement today from the United Network for Organ Sharing (UNOS), the nonprofit organization that manages organ donations in the U.S.
More than 93,000 people in the United States are on the waiting list for a kidney transplant, and the demand far exceeds the supply.
Currently, when kidneys from deceased persons become available for donation, they are offered to transplanted patients based primarily on how long the patients have been waiting for an organ.
While this system can be thought of as fair, "it does not strive to minimize death on the waiting list, nor maximize survival following transplant," UNOS says. In some cases, patients that receive relatively poor kidneys are likely to live many years after their transplants, and later need a second or third transplant from the already limited pool of donated organs.
Under the proposed policy, kidneys would be given a score that reflects how long the organ is likely to keep working in its new owner. People needing transplants would also be given scores — based on their age, years on dialysis and other factors — that reflect how long they are likely to benefit from the transplant.
The top 20 percent of kidneys would be offered to the top 20 percent of patients based on this score, UNOS says. The remaining 80 percent of kidneys would be allocated in much the same way as before.
Children would be prioritized to receive high-quality kidneys — those in the top 35 percent. Patients with very sensitive immune systems, who are extremely limited in the type of organ they can receive, would also have priority over those with less-sensitive immune systems.
Organs with low scores would be offered to patients in a wider geographic area than under the current system, to increase the chances that they would be used rather than discarded.
The changes could result in more than 8,000 total extra years of life, among all patients receiving a kidney in a given year, UNOS says.
However, experts say the effects of the changes will be marginal, and do not change the reality that the demands for organs is still far greater than the supply.
"It's not a major change," because it only affects 20 percent of patients, said George Annas, chair of the Department of Health Law, Bioethics & Human Rights at Boston University School of Public Health. "Obviously, it's not going to solve the shortage of organs problem," Annas said.
To address this problem, doctors need to do more to prevent kidney disease in the first place, so fewer people need transplants, Annas said.
"You can't just look at a shortage problem from the supply side, you have to look at the demand side too," Annas said.
UNOS is seeking comments from the public on the proposed changes until December, and the organization will vote on the proposal as early as June next year.
Pass it on: A new proposal could change the way that 20 percent of donated kidneys are allocated to patients.
Follow Rachael Rettner on Twitter @RachaelRettner, or MyHealthNewsDaily @MyHealth_MHND.

[MommyChick]

Thanks for posting! My mom was just telling me about this story an hour ago & I wanted to look it up

[Chris]

Sensitive immune systems? I am not familiar with this and do not know what they mean by this.

[justme15]

you know, I automatically assumed it meant those with high antibodies.  but upon reading it again, I'm not really sure either what 'sensitive immune systems' means.

[cassandra]

It's a pity they didn't think of that when I was young, and healtyish. But I think its a lot better for the young D- patients of today. And maybe also for the older waitinglisters. Quite some people are going through an awful time after a transplant with a great kidney, and than die. While it could have gone to someone who could actually have benefitted, i.e. live.

But sensitive immune system? No idea

[MightyMike]

Sensitive immune systems means those who are more sensitive to "non self" HLA antibodies such as myself.  I have a higher PRA meaning chance in destroying a kidney.

[cassandra]

sorry Mighty Mike, what are 'non self' HLA antibodies?

[MooseMom]

I'm sure everyone wants to see the perfect kidney matched to the perfect recipient, but how to go about meeting that ideal is fraught with all sorts of obstacles.

A blog entry on the Renal Fellow Network caught my eye.  It made me realize that you could amend the UNOS rules all you want to try to ensure that the number of years of survival per kidney is maximized, but if said recipient is not particularly adherent to their immunosuppressant regime, then anything that UNOS does is moot.

http://renalfellow.blogspot.com/2012/09/medication-nonadherence-in-renal.html

I haven't heard of "sensitive immune systems", either.  I guess that's the problem with getting such nuanced information from Yahoo.com.  LOL!

[MommyChick]

I'm with MM on this.. I believe the "sensitive immune system" has to do with a persons High PRA amount. I know my PRA is extremely high too!
MM- maybe we would have a better chance at winning the lottery then finding a kidney, haha 
Good Luck!

[okarol]

My comment: here's a little more info on this. And there's a poll online.

Proposal to Change the Allocation of Deceased Donor Kidneys: Smart Allocation or Discrimination?
September 25, 2012 By eajkd 2 Comments

Last week the United Network for Organ Sharing (UNOS) set forth proposal 3.5 to change the allocation of deceased donor kidneys. The new proposal aims to improve transplant access to blood type B donors (longest waiting time), increase transplant access to minorities, improve transplantation rates in highly sensitized candidates, enhance sharing of kidneys between regions, and reduce the discard rate of organs. Specific policy changes to achieve these goals include allocating rare A2 blood type kidneys to blood type B recipients, awarding points on a sliding scale to sensitized patients, and allowing patients to accumulate wait time from the point they started dialysis. What has garnered the most attention however, as is summarized in a recent New York Times article, is improving the number of life-years gained from the current deceased donor pool by matching the top 20% of kidneys to the 20% of transplant candidates expected to live the longest.
Kidney quality will be determined by the KDPI (Kidney Donor Profile Index), eliminating standard criteria (SCD) and expanded criteria (ECD) definitions. Donor organs will be divided into 4 groups: KDPI ≤20%, KDPI >20% but <35%, KDPI ≥35% but ≤85%, and KDPI >85%. Organs with KDPI ≤20%, or the “best” organs, will be allocated to those recipients expected to have the longest estimated post-transplant survival (EPTS).  EPTS is based on four factors: age, length of time on dialysis, prior transplant, and diabetes status, all of which are negative factors. Higher EPTS scores are associated with lower expected patient survival. Therefore, this policy creates a disadvantage for older patients, patients with a prior transplant, those who have been on dialysis the longest, and diabetics.
So what is more important—saving more lives or being non-discriminatory? The proposed changes are estimated to result in an additional 8,380 life-years achieved annually from the current pool of deceased donors. It is difficult to argue against allocating the limited pool of kidneys to save as many lives, and for as long as possible. But at the same time, we must ask if there could be a way to still help the older diabetic patients who perhaps need a kidney even more desperately than the younger healthier candidates. Often, elderly diabetic patients do not need a kidney to last longer; rather they need a kidney faster. Evidence of this can be extracted from trials of ECD kidneys. In a 2005 study published in JAMA, it was shown that older diabetic patients enjoy a mortality benefit from accepting an ECD kidney by spending less time on the wait list, while younger healthier patients do not experience the same benefit. A recent study published by AJKD also demonstrated excellent graft survival for elderly transplant patients with ECD kidneys. Therefore, if allocating the “best” kidneys to young healthy patients, perhaps kidneys with a high KDPI should be preferentially allocated to patients with a high EPTS score; or in other words, to elderly and diabetic patients who have been waiting on dialysis the longest. This would allow them to receive exactly what they need—a kidney transplant as fast as possible.
The policy is set for public commentary from September 21to December 14, 2012. It shall be considered by the Board of Directors in June 2013. Approved or not, a heated debate on the allocation of deceased donor organs in the USA is about to ensue.
Dr. Vinay Nair
Mount Sinai School of Medicine
eAJKD Advisory Board member
Share your perspective by taking our quick poll, or leaving a comment: http://ajkdblog.org/2012/09/25/proposal-to-change-the-allocation-of-deceased-donor-kidneys-smart-allocation-or-discrimination/

[Chris]

So how many diabetics, elderly, or what other health problems they may discriminate against end up dying due to the hands they are dealt with? Was that taken into consideration of potential lives saved versus potential deaths with these changes?
 
Just sounds like I'm screwed if I need another transplant later or anyone else who may need another transplant. When it comes to the ECD will patients be told of potential dangers of donor and be able to decline and still  wait for the next call.
 
Lots of things to think about.