Kidney allocation plan could discriminate against older people

Luis Fábregas
| Friday, Feb. 25, 2011

A national proposal to alter the way kidneys are allocated for transplants could discriminate against older recipients, the chief of transplantation at Allegheny General Hospital said yesterday.

"We're not ready to accept this," said Dr. Ngoc Thai, director of the Center for Abdominal Transplantation at the North Side hospital. "It would adversely affect an older population of kidney recipients."

The plan officials are considering would use a transplant candidate's age to determine the age range of prospective donors. The donor of a kidney would have to be 15 years younger or older than the recipient. For instance, someone who is 60 could only get a donor kidney from someone age 45 to 75.

Current rules call for offering kidneys to people who've been waiting the longest. Officials at the United Network for Organ Sharing, a nonprofit that administers organ allocation nationwide for the federal government, said the system needs to be improved with better matching of recipients and donors who are closer in age.

This would reduce the possibility that someone who is expected to live 10 years gets a kidney that may function 40 years, or vice versa.

"The basic premise is to give patients an opportunity to get a kidney that basically 'looks like me,' " said Dr. Mark Aeder, a transplant surgeon at University Hospitals of Cleveland and a member of the UNOS kidney committee considering the idea.

"If you have somebody who's 20 years old, you certainly wouldn't want to give them an organ from a 65-year-old. But a 65-year donor organ, put into a 70-year-old recipient, would be beautiful for 20 years."

Aeder said age-range matching could boost the number of organs from older donors, which often are discarded but could benefit older transplant candidates. Many people older than 60 are added to the transplant wait list, he said.

"There may be some areas of the country where they won't even look at organs that are perfectly good from older donors because they say 'Well, nobody wants an older donor,' so we just wait for younger donors," he said. "But yet we can use those organs because we would have recipients for them. So it may actually provide more organs available."

Thai cautioned that age should not be the sole determining factor in allocating a kidney. Depending on their conditions, he said, a 60-year-old person could be healthier than a 45-year-old.

In 2009, there were 70 kidney transplants in AGH and 167 in University of Pittsburgh Medical Center. The head of UPMC's kidney transplant program was in surgery and could not comment.

UNOS officials said age-range matching may only be one of many factors in allocation. They said the plan has not been presented to the UNOS board as a policy proposal and the kidney committee has until April 1 to get public comments. Thai said AGH plans to send a letter to UNOS outlining its concerns.

Trent Tipple, who received a kidney from a deceased donor 16 years ago when he was 21, said he supports changes in the allocation rules. As a one-time member of the kidney committee, he has spoken to many families of donors who told him they want to see organs from their loved ones go to people who will get the longest benefit.

"I spoke to the wife of a donor who told me she felt like her husband died twice when she heard that the person who received his organ had died," said Tipple, 37, a neonatologist from suburban Columbus, Ohio. "Something needs to be done, because there are years of life being left on the table."

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