The list of Americans waiting for a kidney transplant totals about 93,000. Last year alone, 4,720 of them died waiting for an organ. Yet, each year more than 2,600 donated kidneys are discarded instead of saving a patient’s life. According to the New York Times, some experts believe stifling government oversight, as well as an outdated organ matching program, has led to an inefficient system governing kidney donations and transplants.
“There is no doubt that organs that can help somebody and have a survival benefit are being discarded every day,” Dorry Segev, a transplant surgeon at Johns Hopkins University School of Medicine, told The Times.
The system used to match donated kidneys to transplant recipients has been in place for 25 years and basically relies on a first come, first served federal policy. Under the system, managed by the United Network for Organ Sharing, the country is divided into 58 donation districts. When a kidney is donated, it is offered first to a compatible recipient in the same district who has been on the transplant list the longest. The system also gives additional priority to children and those who have a rare blood type and are less likely to find a match. If a recipient is not found in the district, the network searches for a candidate regionally, then finally expands the search nationally.
Critics argue that, unlike the systems used for liver, heart and lung transplants, the kidney-matching system does not favor or discriminate based on recipients’ life expectancies or transplant urgency. Therefore, according to the Times, an elderly patient might receive an organ that could function for decades, and a lower-quality kidney from an older donor will simply be discarded instead of being matched to a candidate.
“We aren’t maximizing the life benefit from the existing kidney transplants that are available out there,” Northwestern University’s John Friedewald told National Public Radio. “We don’t want to necessarily give a kidney that may last 40 years to someone who is expected to live five more years. We think we can match people in a better way to maximize the outcome from each kidney.”
Under the current system, however, many kidneys are not transplanted because they cannot be matched with a patient, often because of the slim window of time—about 24 hours—that a kidney can be transplanted before it begins to deteriorate.
“Unfortunately, once that kidney is recovered, time isn’t on our side,” St. Paul organ procurement organization LifeSource director Meg Rogers told the Times. “It sometimes takes all the stars aligning.”
Experts are concerned, too, that many donated kidneys are turned away by doctors without proper diagnostic reason, but instead based on pressure from insurance companies and government agencies to keep transplant success rates high. Doctors often biopsy a slice of a donated kidney to test its viability, despite evidence showing biopsies are not a good predictor of transplant success. Yet, according to the Times, hospitals cite biopsy results more than any other reason for discarding kidneys.
Since 2007, transplant centers are federally required to publicize survival data for transplant recipients and organs. If the center underperforms expectations by more than 50 percent, its program will first be flagged, followed by probation and possible Medicare and Medicaid decertification. Experts say it is the fear of government penalties that leads many doctors to be highly selective when it comes to donated organs, which leads to the many discards each year. In fact, the number of kidneys discarded has increased by 76 percent in the past 10 years. Ultimately, however, the cost is patients dying on the transplant list.
Case in point: University of Toledo Medical Center transplant surgeon Michael Rees told the Times after his kidney program was cited by Medicare in 2008, he reduced his yearly transplants from 100 to 60, choosing more selectively the organs and recipients with which he worked. After the reduction, his one-year transplant survival rate increased from 88 to 96 percent.
Which serves America better?” he asked. “A program doing 100 kidneys and 88 percent of them are working, or a program that does 60 kidneys and 59 of them are working? It’s rationing health care under the guise of quality, and it’s a tragedy that we are throwing away perfectly good organs.”