The authors retrospectively analyzed 482 cases of living related kidney donation and transplantation. “The cases were divided into 2 groups by donor age > or =55 years (aged donor group, 136 cases) and <55 years (young donor group, 346 cases).”
“(eGFR) was lower in the aged donor group compared with in the young donor group. After transplant, the mean eGFR of the graft in the recipient was also lower in the aged donor group than in the young donor group.”
“Compared with the young donor group, in the aged donor group incidence of proteinuria and 24-hour urinary protein were significantly higher. However, the incidence of delayed graft function was not significantly different between the 2 groups. We found that aged kidney grafts had no significant effect on long-term patient and graft survivals.”
It’s not surprising the authors focused on the recipients’ results far more than the donors’. While I am hesitant about any study that aims to say “Yes! Let’s use living human beings as medical supply!”, this topic is an important one.
According to the USRDS, the average age of end-stage renal disease onset in the U.S. is 64.4 years old. Meanwhile, the average age of a living kidney donor in the U.S. is 40/41 years old.
As the U.S. population continues to age, the prevalence of ESRD will increase, as will the so-called “need” for donor kidneys. But…
- Family sizes are smaller, resulting in fewer potential biologically related donors (All the current emphasis on “altruistic” or “good samaritan” or non-related donors makes more sense now, doesn’t it?)
- Median age in the U.S. is increasing (Median = midpoint, where 50% are below and 50% are above)
- The U.S. population is suffering from obesity, diabetes, heart disease, etc., which reduces the pool of potential living donors.
- The longer a person lives with one kidney (aka reduced kidney function), the higher their risk of long-term repercussions, cardiovascular disease and death, and renal failure.
- GFR declines naturally as we age, so an older recipient wouldn’t require the same post-transplant GFR as someone much younger.
So, with all that in mind, the use of “older” (over 55yoa) living kidney donors – IF THEY ARE IN REALLY, REALLY GOOD HEALTH AND FULLY INFORMED – makes sense. Transplant algorithms are designed to maximize efficiency, and it’s inefficient to give a recipient expected to live another 10 years a kidney predicted to survive 40 years. More so, the entire justification of living kidney donation is predicated on the idea of the benefit to the recipient outweighing the harm to the donor*, and that simply isn’t the case if the recipient receives 5 years of life while the donor is denied 30 years of full renal function (and all that it implies: adrenal, potassium, vitamin D, etc).
Of course, I also believe that every person who financially benefits from living donation should have to donate – put your money where your mouth is and all that – but for now, I’ll make do with incremental steps toward justice.
Cheng, K., Huang, Z., Ye, Q., Ming, Y., Zhao, Y., Liu, L., Zhang, S., Chen, Z., & Wang, Q. (2015). Midterm Outcome of Living-Related Kidney Transplantation From Aged Donors: A Single-Center Experience Transplantation Proceedings, 47 (6), 1736-1740 DOI: 10.1016/j.transproceed.2015.06.016
* I disagree with this justification, btw; I think it’s total bullshit and inaccurate and dismissive of living donors as separate from their recipients, but that is a subject for another day.