Much ado has been made already about an OPTN proposal to change how deceased donor kidneys are given to folks on the wait list, mostly focusing on the possibility that some people might not get a kidney as quickly as they would under the current system. The trouble with this sort of speculation is that A. there’s an assumption the current system is perfect and B. any change will make it worse.
The truth is, most people don’t really understand how the current allocation system works. They think they know, they might have a vague idea, but they couldn’t pass a pop quiz on the details. If that’s the case, how can they possibly understand the consequences of any proposed changes?
So I’m going to try to explain, in the simplest terms possible, what we’re looking at here. Then, as always, I’m going to encourage you to read the dang proposal for yourself. And send your thoughts and concerns to OPTN by the December 14 deadline. Your voice is your power – use it.
People are added to the kidney transplant wait list when they are determined by a physician to need a transplant.
There is plenty of evidence to conclude that ethnic minorities are listed much later in their disease than their caucasian counterparts. Because the time one spends on the kidney wait list factors into when one receives a kidney, this encourages physicians to list their patients before (perhaps) they really need a transplant, and puts others at a disadvantage because they don’t have access to great preventative care.
Wait time will be calculated not from when a physician adds a candidate but from when the patient starts dialysis or has a GFR of 20 or less (measure of renal function).
Folks remain on the wait list until they either A. obtain a transplant, b. die, or C. are removed by their physician.
For other organs, if a candidate’s health status changes (they grow sicker, or their condition improves), they may be removed from the list temporarily. Not so with kidneys. Folks considered ‘inactive’ remain on the list indefinitely, which has inflated the kidney wait list by approximately 1/3. These inactives compose 52/% of the wait list deaths.
The current proposal changes nothing about this.