Patients over age 65 wait longer than needed for a kidney because physicians fail to list them for ECD donors--study.
Researchers at Johns Hopkins report that older patients could be receiving kidneys from older donors i.e. extended criteria donors (ECDs), but instead are unnecessarily waiting longer for kidneys from younger donors. The results of the study were reported online in recent American Journal of Transplantation (AJT).
"Every adult over 65 should be listed by their physicians for ECDs because the sooner they can get a kidney, the better the chance of survival," said Dorry Segev, MD, PhD, associate professor of surgery at the Johns Hopkins University School of Medicine and the study's leader. "A 65-year-old does not need a 20-year-old kidney; they just need a kidney that will last as long as they will. While young people might have time to wait for the perfect kidney, older people don't.
While older kidneys once were discarded in the belief that they conferred too little benefit, studies over the past decade show they have been used widely and successfully, Segev pointed out. By accepting the ECD kidneys, an older person's chances of survival increase significantly. Older kidneys are not expected to last longer than younger kidneys, but older kidney recipients generally have shorter life spans than younger ones and don't need the organs to last that long.
The researchers based their recommendations after reviewing 142,907 first-time, deceaseddonor kidney registrants reported to the United Network for Organ Sharing (UNOS) between 2003 and 2008. They looked at those who were willing to be listed for ECD kidneys and compared survival rates from the time of registration for those willing to receive ECD kidneys and those who were not. When placed on the UNOS waiting list for an organ, patients of all ages are given the option of being listed for a standard-criteria donor (SCD) kidney only--basically kidneys from donors age 60 or under--or consent to accept an ECD kidney if one becomes available.
The study found those willing to take the older kidneys were more likely to be transplanted and more likely to be transplanted sooner than those only willing to accept younger kidneys.
Consider the following: Older adults represent 50% of dialysis patients in the US and make up a growing portion of the waiting list which now exceeds 100,000; the five year survival rate of people on dialysis for people over 65 is 27%; and one in 10 patients on the waiting list die each year before getting a transplant.
Segev said he was struck by the variation in transplant center listing practices in the US. For instance, some centers list no older patients for older kidneys while some list everyone on the list for the ECD organs. "They're all over the map," he said, and charged that failing to list older patients for ECD kidneys "disenfranchises" them. Johns Hopkins Hospital lists all patients over 65 for ECD kidneys.
He also blamed "regulatory pressure for good outcomes" as contributing to the problem. "There is a tendency for some institutions and some surgeons to be too picky, so these patients who get transplants are guaranteed to do well," Segev noted. "The regulations cover only those who receive transplants. But the harmful effect is you neglect those on the waiting list who instead of being transplanted will die waiting."
For more information, go to http://www.hopkinsmedicine.org/transplant/About/Segev/html
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|Date:||Feb 1, 2010|
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