Experts propose new system for kidney donations

NYT: Changes represent a 'significant departure' from the current system

The committee that oversees kidney transplants in the United States last week announced a series of proposed changes to the system that matches the donated organs with potential recipients.

A report in the New York Times last week noted that many experts believe the country's kidney donation system is made inefficient because of outdated software, burdensome government oversight, doctors relying on inconclusive tests, and federal age-discrimination laws.

As a result, the system might not save as many lives as possible, the Times reported. For example, in 2011, 4,720 people died while waiting for a kidney, while more than 2,600 kidneys that were recovered from cadavers were discarded without being transplanted.

The proposed changes to the system include:

  • A new index to estimate the quality of kidneys recovered from deceased donors;
  • Directing the top 20% of those kidneys, as measured by the new index, to candidates who are expected to live longest after the transplant;
  • The lowest-quality kidneys would be offered to potential recipients in a wider geographic area;
  • Altering the manner in which time on the wait list is measured for potential recipients on dialysis, starting their time when they begin dialysis instead of when they are put on the donation list;
  • Changing the way priority is given to difficult-to-match recipients, from receiving priority points that moved them up the list to awarding those points on a sliding scale based on how difficult it is to find a viable match; and
  • Allowing potential recipients with type B blood -- who typically have the longest wait times -- to receive kidneys from donors from an expanded group of blood types.

According to the Times, the changes are a "significant departure" from the current system for people who would receive the top 20% of kidneys. However, the new process represents "little change" for the remaining 80% of donors, the Times reports.

Still, the committee that developed the new proposals used computer simulations to estimate that they would result in an additional 8,380 years of life from one year of transplants. Although that is only about half as many years as estimated for a previous proposal from the committee, which would have matched kidneys to donors by age, that proposal was abandoned because federal officials noted that it would have violated age-discrimination laws.

The changes are open for public comment until Dec. 14 (Sack, New York Times, 9/21).

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