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Deceased Organ Donation Transplant Wait List

Proposed Kidney Allocation Policy, pt 2 – waitlist time

An addendum to my prior post: Part of the reason why there are so few deceased donor kidneys over the age of 64 is because, until recently, they weren’t procured (obtained/harvested). The general rule was that an organ had to under 60 to be considered viable. With the introduction of Expanded Criteria Kidneys, this has begun to change. Expanded Criteria doesn’t refer to solely to age, but to some other factors as well (diabetes, hypertension, etc). Increased use of these organs could shift some of the stats, as well as increase the total number of kidneys available for transplantation.

Now on to today’s post…

Another aspect of the proposed kidney allocation policy is a shifting from wait time as a factor to ‘time on dialysis’. I expect that a number of people will have an instaneous negative reaction to this idea (and have, if internet comments are any barometer), so it’s important to clarify the reasoning behind this change.

1. Kidneys are currently the only organs that utilize wait time as a factor. This isn’t because other organs are ‘behind’ but because it’s already been determined that wait time isn’t an efficient or fair way to allocate organs.

2. Utilizing wait time as a factor is a violation of NOTA 1984 (fair and equitable allocation) and the Final Rule (medical need first).

Some folks have chronic kidney disease while others suffer a traumatic event which destroys their renal function. Some fare well on dialysis and others do not. Should a person who is stable on dialysis receive a kidney before someone whose condition is deteriorating quickly just because the former has been listed six months longer than the latter? Especially if there’s a good possibility the latter will die before another kidney becomes available, which isn’t the case for the former? (The ethical answer here is NO)

Another problem with utilizing wait time is this: while there are guidelines in how and when an individual should and can be listed, much of it is left to the physician’s discretion. If wait time remains a factor, it motivates a doctor to list a patient as soon as possible, thereby artificially inflating the list. Another unintended consequence could be the perception of longer wait times in certain regions because those listed are healthier, and therefore passed over in favor of those in more medical need. Or, because of our regional system, it can mean that those in greater medical need outside the region never have the opportunity to procure an organ because they’re given to the healthier in-region recipient. These inauthentically long wait times can scare people, make them desperate and possibly erode the public trust in the system. None of which are good things.

Finally – I’ve heard the arguments about how ‘horrible’ life is on dialysis. My response: be grateful there’s a treatment available at all. You could be like any other organ recipient who has no alternative or stop-gap measure. The waitlist exists to save lives, not improve someone’s quality of life. Since the ‘list’ isn’t really a ‘list’, stop complaining that someone cut in front of you. No one is entitled to a transplant.

PS. Speaking of wait list inflation and otherwise: before 2003, those individuals who received living donor organs did not pay a registration fee to UNOS because they were often not wait listed. In that year, even though there is no legal basis for this decision, UNOS decided they wanted a fee from EVERY person in the US who underwent an organ transplant. So now, even if a living donor is waiting in the wings, a would-be recipient must be placed on the wait list and a registration fee paid.

Oh and let’s not forget that a fee is paid for each REGISTRATION – think Steve Jobs -and not for each candidate.

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