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Don't waste kidneys; organ transplant reform needed

Published: Thursday, Oct. 4 2012 12:00 a.m. MDT

The following editorial appeared recently in the Chicago Tribune:

Every year, too many kidneys recovered from deceased donors don't end up in transplant patients. They end up in medical waste incinerators.

Last year, 4,720 people died while waiting for kidney transplants. Meanwhile, 2,644 kidneys were discarded.

Some of these kidneys had problems that rendered them unfit for transplant. But many could not be transplanted because the system for allocating them is inefficient and outdated.

Right now the waiting list for a kidney transplant stands at 93,702 people. The system isn't saving — or improving — as many lives as it could.

A committee that oversees kidney transplants in the United States recently proposed a series of smart changes to better parcel out 14,700 kidneys recovered from deceased donors.

Under this plan, the top 20 percent of kidneys — the kidneys expected to last longest — would be directed to those candidates expected to live the longest after a transplant. That typically means younger patients.

That proposal is a significant departure from the current system, which generally can be summed up as: Get in line and wait your turn. Depending on what part of the country you live in and other variables, you could wait two years or 10.

The committee's chairman, Dr. John Friedewald, a transplant nephrologist at Northwestern University's Feinberg School of Medicine, tells us the new plan — called "longevity matching" — will help doctors "get more out of what we have."

The proposed changes would yield an estimated 8,380 more years of life from one year of transplants. Think about that: 8,380 years.

This new proposal is similar to but not as aggressive as a 2007 plan that would have doled out kidneys more often to those who could live longest after transplant. But that proposal ran afoul of the federal government, which warned last year that it would violate age discrimination laws.

Yes, this plan still tips the scale in favor of some younger patients. But it will still be possible for some in their 40s and 50s to make the cut and get the best organs, Friedewald says. Even those who don't make that cut will still be eligible for a transplant. Bottom line: The system won't drive as many older organs to younger recipients, who may outlive them and wind up on the list again. A similar concept is already part of the system to determine who receives a transplanted lung, hearts or liver.

We understand why some people are nervous about these changes. In a fairer world, there would be enough kidneys to go around. But there aren't. This is about maximizing the years that a kidney will work inside someone's body, not rendering a judgment about how any recipient uses that time.

Officials have spent the past nine years seeking to make the system more efficient. Let's not wait another nine. The board that oversees transplants in the U.S. can — and should — make these changes next summer. Thousands of people are on kidney transplant waiting lists. Every day, every week, that officials delay, people die waiting.

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