US discards thousands of donated kidneys that could save lives
Adrianna Rodriguez
The United States discards about 3,500 donated kidneys a year, many of which could be used to save lives, new research shows.
The study, published this week in the journal JAMA Internal Medicine, focused on the rate at which donated kidneys were used in the United States and France between 2004 and 2014. In that time, the U.S. discarded 17.9% of the kidneys it recovered, while France discarded 9.1% of the kidneys it recovered. In all, the U.S. threw away almost 28,000 donated kidneys in that 10year period.
Nearly 100,000 Americans are on
An estimated 12 people die each day waiting for a kidney transplant while about 10 kidneys a day are discarded.
National Kidney Foundation
the waiting list for a kidney transplant, and an average of 12 people die each day waiting for a kidney transplant. Meanwhile, about 10 kidneys are discarded daily, according to the National Kidney Foundation, which is based in New York City.
The study showed that kidneys discarded in the U.S. were on average about 36 years old, while kidneys discarded in France were on average about 50 years old. That means France had a higher kidney acceptance rate from older donors.
The study found that the U.S. is more likely than France to throw away kidneys when the donor had hypertension, diabetes, a heart attack or tested positive for Hepatitis C.
But that doesn’t mean those kidneys can’t be used to save lives.
“They should definitely be used and are definitely viable,” said Sumit Mohan, associate professor of medicine and epidemiology at Columbia University in New York. “Using kidneys from diabetic donors do remarkably well.”
Mohan said the alternative to not having a transplant – going on dialysis – is much worse than having a lesser quality kidney. The mortality rate for patients that go on dialysis is about 20% annually, which works out to be a five-year survival rate.
“It’s comparable to some of the worst cancers we see,” Mohan said.
A kidney can survive outside the body for 36 to 48 hours after it’s recovered.
Health Resources and Services Administration That means organ procurement organizations (OPO) have a running clock to find a transplant center that will accept the donated kidney before the kidney becomes unviable for a patient on the waiting list.
132,000 years of life
Mohan said the average kidney experiences about a 1% decline in function per year when a person enters their 30s. However, the difference in kidney survivability between a 30year-old donor and a 50-year-old could be as little as six months.
“People aren’t asking ‘What’s the quality of my kidney?’ ” Mohan said. “The question that everybody asks is, ‘When am I getting my kidney?’ ”
The JAMA study found that by adopting the French model of aggressive acceptance, the U.S. would have been able to use almost 17,500 kidneys over the 10-year period – or about 62% of the kidneys that were thrown away.
The study concluded that those kidneys could have generated an extra 132,000 years of life.
While France is accepting lesser quality kidneys, a 2013 study found that Europe has better kidney survivability outcomes compared with the U.S. It found that five- and 10-year graft survival rates in Europe were about 77%, while the survival rates in the U.S. were 56%.
In order to adopt European practices, experts say the U.S. has to change a system that’s inherently broken.
The quality of a donated kidney is determined by its Kidney Donor Profile Index (KDPI). A kidney’s KDPI is calculated using age, height, weight, ethnicity, health history and cause of death, among other characteristics, according to the Organ Procurement and Transplantation Network. A higher KDPI is a lower quality kidney, and a lower KPDI is a higher quality kidney.
Kevin Longino, CEO at the National Kidney Foundation, says pressure to accept higher quality kidneys comes from hospital administrators who want to keep costs as low as possible.
Almost all kidney transplants are covered by Medicare, but the covered cost is the same no matter how long the patient stays in the hospital. “Kidneys that have higher KDPIs take longer to ‘wake up,’ ” Longino said. “Administrators don’t want to take the risk because they don’t get reimbursed for the number of days that they’re hospitalized.”
Mohan said there are also regulatory pressures from Medicare, which requires doctors to keep a certain standard of transplant outcomes. That requires doctors to be more conservative when choosing to accept or reject a kidney for their patient.
Centers for Medicare and Medicaid Services recently recognized the problem by releasing an 800-page proposal in July that would see a massive overhaul to organ transplant regulations.
Another challenge is that the more time it takes a transplant center to accept a kidney, the higher chance the kidney will ultimately be discarded. A kidney can survive outside the body for 36 to 48 hours after it’s recovered, according to the federal Health Resources and Services Administration. That means organ procurement organizations (OPOs) have a running clock to find a transplant center that will accept the kidney before the kidney becomes nonviable.
When the clock is running
Transplant centers have a right to refuse kidneys for any reason and must make that decision in 60 minutes before an OPO takes the kidney to another transplant center.
More transplant centers are using biopsies to help them with that decision. But Mohan says the natural time constraints mean that these biopsies are rushed and incorrectly interpreted.
That leads to a higher rejection by transplant centers. Mohan said a stricter use of biopsies could make all the difference.
“What’s happening is that kidney biopsies are being used despite the fact that they’re mostly wrong,” Mohan said.
Login said these biopsies can be fatal to a kidney because it eats away at the time OPOs have to offer the kidney to another transplant center. Often times, transplant centers are biased against kidneys that have been rejected before.
“Not only can they refuse a kidney, but they can slow the whole system down for someone to be able to accept,” Login said.
Although OPOs work quickly through automated systems to find a patient who matches, hundreds of transplant centers can reject a kidney in the short time before it is discarded, said Howard Nathan, president and CEO of the Gift of Life Donor Program in Philadelphia.
Nathan said the discard rate for a kidney with a high KDPI is in the range of 40% to 50%. But out of the 2.4 million people who die every day, only 15,000 people can be potential organ donors.
“That’s why you don’t want to waste a gift that’s given,” Nathan said.