Organ donors who need kidneys jump to front of transplant line

By Ronnie Cohen

NEW YORK (Reuters Health) - Living organ donors who later need a kidney go to the top of the transplant waiting list and get higher quality kidneys than their counterparts who were not donors, a new study found.

The finding shows that a U.S. policy prioritizing previous organ donors on the transplant waiting list is working, the study's lead author, Dr. Peter Reese, told Reuters Health.

"A lot of donors I meet want reassurance that if they do reach end-stage renal disease they'll receive priority on the transplant list," he said. "I think this study provides an important piece of reassurance."

Reese, from the University of Pennsylvania's Perelman School of Medicine in Philadelphia, and colleagues compared 239 prior organ donors to similar non-donors who were wait-listed for transplants from 1996 until 2010.

The median wait for a new kidney was 145 days for the donors, compared to 1,607 days for patients who were similar to them but hadn't ever donated an organ, the study found.

It also found that 5% of prior organ donors died before receiving a transplant, compared to 13% of the matched candidates.

"It's an important validation that the system works," Dr. Dorry Segev told Reuters Health. Segev is an epidemiologist and transplant surgeon at Johns Hopkins School of Medicine in Baltimore, Maryland and was not involved with the current study.

"We in transplantation have put in a rescue system for the rare kidney donor who happens to develop kidney failure . . . and this is evidence that this system is working well," he said.

Since 1996 in the U.S., living organ donors have been granted priority for kidneys procured from deceased donors, the authors wrote November 20 in the Journal of the American Society of Nephrology.

The selection criteria for living donors are designed to identify individuals who are at low risk for ultimately needing kidney transplants themselves. Recent research has found, however, that although the risk of a donor later needing a new kidney remains low, it is eight times higher than the risk for the average healthy person, the new study says.

But, Reese said, it's still a very rare event.

Over the years of the study, there were more than 84,000 living kidney donors in the U.S. alone, according to data from the Organ Procurement and Transplantation Network.

Segev said his research shows that the absolute risk of kidney failure for prior donors is 31 out of 10,000, compared to 27 out of 10,000 for non-donors.

He was not surprised to see that the system of prioritizing donors is working. But he said the question that continues to concern him is whether prior donors who develop kidney failure are being sent to transplant centers for evaluation.

Segev is studying that question.

Since the 1990s, advances in immune-suppression have made it safer to receive organs from unrelated donors. Less invasive surgical techniques also make it easier to donate.

"We have to really impress on donors that if they donate they're committing to a healthy lifestyle," Reese said.

"There is definitely risk," he said. "But I think my job is to choose people whose risk is low, reasonable and who are not ambivalent."

SOURCE: http://bit.ly/1F9WswL

J Am Soc Nephrol 2014.

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