WHICH CRI­TE­RIA RE­ALLY DE­CIDE WHO RE­CEIVES A DO­NATED OR­GAN?

World of Knowledge (Australia) - - Human Body -

In 2015, 435 or­gan donors gave 1,241 Aus­tralians a new chance in life. In fact, the num­ber of peo­ple do­nat­ing or­gans in this coun­try is now at a record high.

But wait­ing times for in­di­vid­u­als des­per­ate for an or­gan can be ex­tremely long – any­thing from six months to four years, which some­times can mean the dif­fer­ence be­tween life and death.

So does your chance of re­ceiv­ing an or­gan in­crease the longer you’re on the wait­ing list? Not nec­es­sar­ily, be­cause when speak­ing to se­ri­ously ill pa­tients, some doc­tors are not com­pletely hon­est. Along­side the ‘hard’ cri­te­ria that de­ter­mine whether a donor or­gan is right for a pa­tient, such as a per­son’s blood type and age, there are also nu­mer­ous ‘soft’ cri­te­ria that play a cru­cial role in the al­lo­ca­tion of or­gans.

For ex­am­ple, many of those af­fected do not re­alise that the rank­ing of pa­tients on the trans­plant list is cal­cu­lated anew for ev­ery donor or­gan that be­comes avail­able. This means a pa­tient might be sec­ond on the list in one case, but right at the bot­tom in an­other, de­pend­ing on blood type and spe­cific cir­cum­stances.

But even if the dice are rolled in the pa­tient’s favour, they will not au­to­mat­i­cally be se­lected for a trans­plant – far from it. In fact it doesn’t even mean they will get a new or­gan at all.

How can that be the case? In a nut­shell: once the list of pa­tients el­i­gi­ble for a kid­ney trans­plant has been whit­tled down to just two us­ing the hard cri­te­ria, there’s a dilemma.

For the es­ti­mated 40,000 peo­ple wait­ing for a kid­ney in western Europe, it is a prob­lem that oc­curs more fre­quently than many would be­lieve. To se­lect a pa­tient for an or­gan in this in­stance, doc­tors must also take soft cri­te­ria into ac­count. These are of­ten based on sub­jec­tive as­sess­ment. The doc­tors re­spon­si­ble must de­cide on an or­gan re­cip­i­ent us­ing fac­tors like life­style or like­li­ness to keep up with the gru­elling anti-re­jec­tion drugs regime re­quired af­ter the trans­plant – and it’s a mad­den­ingly dif­fi­cult task.

In prac­tice that might mean that a 47-year-old has a lower chance of be­ing al­lo­cated a donor liver than a 17-year-old with a ge­netic con­di­tion who is oth­er­wise healthy. For crit­ics that’s a bit­ter pill to swal­low: with­out ob­jec­tive cri­te­ria, they be­lieve a red line is crossed. Pa­trick Mcma­hon, a trans­plant co­or­di­na­tor, has even ac­cused doc­tors of “play­ing God”.

“Why trans­plant medicine is not sub­ject to cer­tain dis­clo­sure obli­ga­tions is a mys­tery to me.” PAOLO BAVASTRO, CAR­DI­OL­O­GIST

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