LITTLE ROCK — The nation’s organ-transplant network is considering giving younger, healthier people preference over older, sicker patients for the best kidneys.
Instead of giving priority primarily to patients who have been on the waiting list longest, the proposed rules would match recipients and organs to a greater extent on the basis of factors such as age and health to try to maximize the number of years provided by each kidney - the most sought-after organ for transplants.
“We’re trying to best utilize the gift of the donated organ,” said Kenneth Andreoni, an associate professor of surgery at Ohio State University who chairs the committee that is reviewing the system for the United Network for Organ Sharing, a Virginia-based private nonprofit group contracted by the federal government to coordinate organ allocation. “It’s an effort to get the most out of a scarce resource.”
The potential changes, which would be part of the most comprehensive overhaul of the system in 25 years, are being welcomed by some bioethicists, transplant surgeons and patient representatives as a step toward improving kidney distribution. But others have said the new system would unfairly penalize middle-aged and elderly patients at a time when the overall population is getting older.
“The best kidneys are from young adults under age 35 years. Nobody over the age of 50 will ever see one of those,” said Lainie Friedman Ross, a University of Chicago bioethicist and physician. “There are a lot of people in their 50s and 60s who, with a properly functioning kidney, could have 20 or more years of life. We’re making it harder for them to get a kidney that will function for that length of time. It’s age discrimination.”
More than 110,000 Americans are listed as waiting for organs, including more than 87,000 who need kidneys. Only about 17,000 Americans get kidneys each year, and more than 4,600 die because they did not get one in time.
“It’s a big shift,” said Arthur Caplan, a University of Pennsylvania bioethicist. “For a long time, the whole program has been oriented toward waiting-list time. This is moving it away from a save-the-sickest strategy to trying to get a greater yield in terms of years of life saved.”
If adopted, the approach could have implications for other decisions about how to allocate scarce medical resources, such as expensive cancer drugs and ventilators during hurricanes and other emergencies, Caplan said.
“This is a fascinating canary-in-a-cave kind of debate,” he said. “We don’t want to talk about rationing much in America. It’s become taboo in any health-care discussion. But kidneys reminds us there are situations where you have to talk about rationing. You have no choice. This may shine a light on these other areas.”
The current system, which dates from 1986, was first based largely on giving kidneys to the patients who matched the organs best, but it evolved to take a first-come, first-served approach made possible by safer, more powerful anti-rejection drugs.
Today, the United Network for Organ Sharing’s Organ Procurement and Transplantation Network gives priority to patients seeking organs based mostly on who has waited the longest.
“It was just a fairness issue,” Andreoni said. “You’re next in line. It’s your turn.”
The problem is, in some cases, elderly recipients get organs from much younger donors whose kidneys could have provided far more years of healthy life to younger,healthier patients. Younger patients can receive older or less-healthy organs that wear out more quickly, forcing them back onto the transplant list in a few years.
The 30-member Kidney Transplantation Committee, which has been reviewing the system for about six years, last week quietly began circulating for public comment a 40-page document outlining possible revisions.
Under one scenario, for 80 percent of kidneys, patients 15 years older or younger than the donor would get higher priority. The remaining 20 percent of organs - those deemed to have the best chance of lasting the longest on the basis of the age and health of the donor and other factors - would be given to recipients with the best chances of living the longest on the basis of criteria such as their age, how long they’ve been on dialysis and whether they have diabetes.
Although many of the details about how the new concept would be implemented still have to be worked out, Jill McMaster, a United Network for Organ Sharing board member representing the public, and others said it is likely to be adopted.
The public has until April 1 to comment on the idea, which would make the kidney system more similar to those used to allocate livers, hearts and lungs. The committee will take those comments into account before formally proposing the specific changes, which will be open to public comment again before going to the system’s board of directors. The board could approve final changes by June 2012.
Front Section, Pages 4 on 02/26/2011