New rules for kidney transplants discussed in St. Louis

[okarol]

New rules for kidney transplants discussed in St. Louis
By Blythe Bernhard
ST. LOUIS POST-DISPATCH
01/27/2009

The ultimate problem with organ transplants is more people need them than there are organs to go around.

That fact was at the center of the discussion Monday when the Kidney Transplantation Committee of the United Network for Organ Sharing met at the Four Seasons Hotel downtown. The group is considering changing the way kidneys from deceased donors are distributed.

Rules for kidney allocation were made more than 20 years ago, and rely heavily on a formula involving genetic tissue compatibility between the donor and the recipient. As science has developed better drugs to suppress the rejection of new organs, the compatibility factor has become less important.

Under contract with the government, the private organ network tries to create the most equitable system to decide who receives available organs. With kidneys it's more difficult to tell which patients would benefit most from transplants because people can stay relatively healthy, although physically and psychologically burdened, on dialysis.

The kidney committee has been studying new formulas for allocating the precious organs for several years and came to St. Louis this week seeking input from doctors and patients.

"The goal is that the organs will go to the people that will benefit most with life years," said Dr. Gene Ridolfi, director of Barnes-Jewish Hospital's transplant center. "How do we best allocate and have the best outcomes for a population with a very scarce resource?"

The committee discussed three concepts that could be used in a new system to determine who gets kidneys:

— A formula that determines how long a patient can expect to live after receiving a new kidney.

— The amount of time a patient has been receiving dialysis treatments.

— A measure of the quality of the donated organ in relation to the candidate's age and health.

As the population ages, high-quality younger organs are becoming more scarce. Doctors at the forum expressed concern that the new formula puts older patients at a disadvantage because the quantity and quality of organs available to them will be diminished. Because the system would be balanced toward generating as many years of life after a transplant as possible, more older people could die on waiting lists without receiving transplants, doctors said.

But because of the ongoing shortage of organs, "you're always going to have to distribute organs to someone with an advantage," said Dr. Robert Higgins, chairman of the United Network for Organ Sharing.

Nearly 80,000 people are on waiting lists nationwide to receive kidney transplants, and about 10,000 receive an organ each year from a deceased donor. About 160 people in the St. Louis area received kidneys in transplants performed in 2007 at four hospitals: Barnes-Jewish Hospital, St. Louis University Hospital, Cardinal Glennon Children's Medical Center and St. Louis Children's Hospital.

Steve Korenblat has polycystic kidney disease and has been on the transplant waiting list at Barnes-Jewish for two years. He told the kidney committee that a complete change in the rules could hurt the people who have been waiting under the current system.

"Frankly I don't think people appreciate what a tremendous problem that would create," said Korenblat, 60. "It's a tough issue."

Several people at the meeting also expressed concern that the focus of the transplant committee should be on encouraging more people to agree to donate their organs when they die.

Changing the way kidneys are given out "doesn't deal with the other issue of expanding the donor pool," said Dr. Harvey Solomon, a kidney and liver transplant surgeon at St. Louis University Hospital. "We still have a turn-down rate that is inexplicable to me. It should be part of a social contract."

For more information or to submit comments to the organ network, visit unos.org.