Changing guidelines would increase viable kidneys

At this moment in time, there are 95,307 people on the waiting list for a kidney transplant in the United States. 

This number is especially harrowing when considered in combination with the fact that in 2017, a meager 15,218 kidneys were donated in the U.S. According to the Organ Procurement and Transplantation Network, an average of 3,000 new patients are added to the kidney waiting list each month, and 4,761 patients died while waiting for a kidney transplant in 2014 alone. 

In light of the severity of the lack of kidneys, up to 20 percent of recovered kidneys in the U.S. are discarded before transplantation; potentially lifesaving organs are being thrown out in this country every day. 

One way that the number of lives saved by kidney transplants could increase is by adjusting guidelines that determine transplantability. At the American Society of Nephrology’s (ASN) Kidney Week Conference at the San Diego Convention Center last week, researchers presented a study comparing kidney donor and transplant data between France and the U.S. The results of this new study suggest that some kidneys discarded in the U.S. over the past decade could have been used successfully.

Numbers indicate that approximately 2,000 donated kidneys are discarded in the United States each year, despite a shortage of these organs.

Olivier Aubert and Alexandre Loupy, two researchers who work at the Paris Translational Research Center for Organ Transplantation, compared kidney quality and outcomes between the United States and France by analyzing data from the United Network for Organ Sharing and from the French Organ Procurement Agency. 

Between 2004 and 2014, 156,089 kidneys in the United States and 29,984 kidneys in France were procured for transplant. A much higher proportion of transplanted French kidneys were considered high-risk organs, as measured by the kidney donor profile index (KDPI). The kidney donor profile index (KDPI) is a metric that predicts the likelihood of failure after a kidney is transplanted from a deceased donor. The KDPI indicates how long a kidney is expected to function in comparison to other kidneys recovered in the U.S. during the last year. Lower KDPI scores are associated with a longer function. For example, a kidney with a KDPI of 20 percent is expected to last a shorter amount of time than 20 percent of recovered kidneys or a longer amount of time than 80 percent of recovered kidneys. 

The study suggests that many transplanted French kidneys would have had a high probability of being discarded if they had been in the U.S. Loupy and his colleagues also found that if American centers had been willing to accept kidneys from older and higher-risk donors, an estimated 132,445 additional years of life would have been provided to U.S. transplant candidates between 2004 and 2014. 

“The global shortage of organs for transplantation is a major public health concern,” Loupy said in a recent press release. “New, creative solutions to address this concern are needed. By comparing transplant practices in two countries, we provide fresh evidence that older deceased donor organs are a valuable underutilized resource.”

The mean amount of time patients spend on the waiting list for kidney transplant is approximately 3.6 years, according the National Kidney Foundation. On average, 13 people die each day awaiting a kidney transplant in the U.S. The new study suggests that some of these lives could be saved if transplantability guidelines in the U.S. are adjusted to allow kidneys from older donors to be used. 

While the recent findings offer promise for those on the kidney transplant waiting list, the authors of the study note that further research should be done to compare donor data and transplantation outcomes across borders. Insights gained from this type of study could help researchers determine a more accurate point at which a kidney should not be used for transplant.