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Understanding The Choices In Kidney Transplants

February 17, 2010
According to researchers from Johns Hopkins, 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 line for organs from from older donors (called extended-criteria donors or ECDs) and instead have them unnecessarily wait 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 kidney, the better the chance for survival," says transplant surgeon Dorry L. 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." Older adults represent half the 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. Studies over the past decade, including the current one by Johns Hopkins researchers, show that ECDs 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. To arrive at their findings, researchers reviewed over 140,000 kidney registrants and 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 or 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. Segev found wide variation in listing practices among transplant centers. Some centers list no older patients for older kidneys, while some list everyone for those organs. Failing to list older patients for ECD kidneys "disenfranchises" them, he says, calling for patients to be better educated about their options. At The Johns Hopkins Hospital, all patients over 65 are listed for ECD kidneys.