Seniors stymied in wait for kidney transplants

Feb 16, 2010

One-third of people over the age of 65 wait longer than necessary for lifesaving, new kidneys because their doctors fail to put them in a queue for organs unsuitable to transplant in younger patients but well-suited to seniors, research from Johns Hopkins suggests.

Results of a study reported online in the show that older patients could be receiving kidneys from older donors (called extended-criteria donors, or ECDs), but instead are unnecessarily waiting longer for kidneys from younger donors.

"Every adult over 65 should be listed by their physicians for ECDs because the sooner they can get a , the better the chance for survival," says Dorry L. Segev, M.D., Ph.D., 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, including the current one by Johns Hopkins researchers, show they have been widely and successfully transplanted.

By accepting these kidneys, an older person's chances for survival increase significantly, Segev says. Older kidneys are not expected to last as long as younger kidneys, but older kidney recipients generally have shorter life spans than younger ones and don't need the organs to last as long, Segev says.

Researchers reviewed 142,907 first-time, deceased-donor kidney registrants reported to the United Network of Organ Sharing, the national organization in charge of organ allocation, between 2003 and 2008. They looked at those who were willing to be listed for ECD kidneys and compared survival rates from time of registration for those willing to receive ECD kidneys and those who were not.

When placed on the waiting list, patients of all ages are given the option of being listed for a standard-criteria donor (SCD) kidney only — basically kidneys from donors under 60 — or consent to accept an ECD kidney if one becomes available first.

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, the study found.

Older adults represent half of dialysis patients in the United States and a growing proportion of the national waiting list. Five-year survival on dialysis for people over 65 is 27 percent. One in 10 patients on waiting lists will die each year before they are transplanted.

Segev says he was struck by the variation in listing practices among transplant centers. Some centers list no older patients for older kidneys, while some list everyone for those organs. "They're all over the map," Segev says. Failing to list older patients for ECD kidneys "disenfranchises" them, he says, calling for patients to be better educated about their options.

Segev suspects that "regulatory pressure for good patient outcomes" contributes to the problem. "There is a tendency for some institutions and some surgeons to be too picky, so that those patients who get transplants are guaranteed to do well," he says. "The regulations cover only those patients who receive transplants. But the harmful effect is you neglect those on the waiting list who instead of being transplanted will die waiting."

At The Johns Hopkins Hospital, all patients over 65 are listed for ECD kidneys. Segev has grants from the National Institutes of Health's National Institute on Aging and the American Geriatric Society to look at the issues of older adults considering kidney transplantation.

Explore further: Face transplants change lives, identity

Provided by Johns Hopkins Medical Institutions

not rated yet
add to favorites email to friend print save as pdf

Related Stories

Extreme obesity affects chances of kidney transplantation

Jan 10, 2008

For patients on the waiting list for a kidney transplant, severe and morbid obesity are associated with a lower chance of receiving an organ, reports a study in the February Journal of the American Society of Nephrology.

Increasing the number of kidney transplants

Aug 20, 2009

In most transplant centers, the kidneys of very young deceased donors are transplanted together into one patient. According to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (C ...

Recommended for you

Face transplants change lives, identity

3 hours ago

Patients are prepared to take significant risks in order to be considered for a face transplant, says Dr David Koppel, director of the largest craniofacial unit in the UK and Honorary Clinical Associate Professor ...

British Lords hold ten-hour debate on assisted dying

Jul 19, 2014

Members of Britain's unelected House of Lords spent almost ten hours on Friday discussing whether to legalise assisted dying, in an often emotional debate putting the question back on the agenda, if not on the statute books.

AbbVie, Shire agree on $55B combination

Jul 18, 2014

The drugmaker AbbVie has reached a deal worth roughly $55 billion to combine with British counterpart Shire and become the latest U.S. company to seek an overseas haven from tax rates back home.

User comments : 0