Ethical Considerations Living Donor Misinformation Organ Allocation

Hey New York Times – Living Donors Are People Too

The following is an op-ed I submitted to the New York Times last week in reaction to two op-eds run by the publication: one by Lainie Ross, whining about the proposed kidney allocation policy and getting it wrong, and a response by Brody from the National Kidney Registry. The New York Times apparently doesn’t think correcting misconceptions about living donors is important for their pages:

I am appalled by Mr. Brody’s statement: “The real problem [of the organ shortage] is the shortage of living kidneys”.

It has been over fifty years since the first living donor kidney transplant, and the transplant industry still has no long-term data, no standardized evaluation, selection and treatment criteria, and no structured aftercare or support services. Over four living kidney donors die each year in the US within 12 months of surgery. Many others experience debilitating complications: hernia, chylous ascites, pancreatits, adrenal dysfunction, testicular swelling and sensitivity, nerve damage, and chronic fatigue and pain. An estimated 20-30% suffer from depression, anxiety and PTSD, yet not a single transplant center offers experienced mental health services.

The reasons for the organ shortage in the US are three-fold:

1. The aging of the US population. Renal function deteriorates with age. According to the US Renal Data System, the average age onset of end-stage renal disease is 64.4 years old. Yet according to OPTN, transplant centers routinely discard viable organs from donors over the age of 50.

2. Geographical hording. Despite the parameters of the National Organ Transplant Act of 1984 and its 2003 revisions, and CMS Final Rule 2007, we do not have a true national allocation system. Donated organs are offered to recipients within the local hospital first, then the OPTN region (or DSA) and then finally, nationally.

3. Transplants are NOT cures. According to SRTR, 18% of individuals on the kidney waitlist at any time have had at least one prior transplant. Meanwhile, 1/3 of candidates on the waitlist are inactive, meaning they couldn’t accept a transplant even if an organ became available.

Laine Ross and her ilk continue to misrepresent the proposed kidney allocation changes. The current system allows recipients with five-year post-transplant life expectancies to receive kidneys expected to last twenty years, and vice versa. The proposed changes are while far from perfect – they do not address geographical disparities and in some ways, seem to exacerbate them – but they do attempt to minimize the number of transplants each recipient must endure to achieve a ‘normal’ lifespan while facilitating the use of over-50 donor organs for like-matched recipients.

While I appreciate that Mr. Brody is simply earning his paycheck as an employee of the National Kidney Registry, it is abhorrent for him to treat living donors so callously. The public are real people with families, friends, dreams and aspirations, not organ incubators for those with end-stage renal disease.

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