“The doctor told my parents that I had too many complications which caused my kidneys to fail. He told them he doesn’t see me living past the age of 3,” said Ahmad Alsardary, 24-year-old student studying occupational therapy at the University of the Sciences in Philadelphia. Ahmad is one of 118,094 in the United States struggling to carry out vital life functions due to organ failure – a statistic that is constantly updated by the Organ Procurement and Transplantation Network (OPTN). OPTN advertises “the need is real” with a new patient being added every ten minutes and about eighteen people dying each day waiting for one. One organ donor can save up to 8 lives or help nearly 50 people.
MaryClare Cosner, nursing student at the University of Pittsburgh, says her experiences observing organ donation are incomparable to anything else she has experienced in her education. “Not only did he [a donor] save a woman’s life but his gift also benefited 19 other individuals awaiting organs, corneas, and skin grafts. The choice of people to benefit others with their bodies after death can, and does, provide the recipients with previously unattainable experiences. It enables the recipients a new lease on life and the donors a way to leave their mark on this world,” said Cosner.
Sadly for Ahmad the need is certainly very real as the kidney is the most sought out organ with nearly 94,000 people on the kidney transplant list. The kidneys are responsible for the filtration of blood in our body. Blood volume is filtered nearly 60 times per day. Filtration removes excess salt, water, and waste products, which is necessary for normal maintenance of salt and water balance of the body. This balance is essential to homeostasis – the relatively stable and constant conditions of the human body for optimal function. Disruption of homeostasis from kidney disease occurs because chemicals build up in the body, which causes tremendous pain and suffering and could even result in death.
Ahmad was born with nephrotic syndrome, a disease in which the kidneys are damage. He was 5 years old when his kidneys both failed and he had to start dialysis. Dialysis is an artificial treatment for those who have lost kidney function. It works in the form of temporary mechanical blood filtration. “I was on dialysis for a few years and then in 1998, I received a kidney transplant from somebody who got in a car accident. I remember it was like it was yesterday. I was in class and my teacher told me go to the principal’s office. As I walked to the principal’s office, I wondered what I had done. My mom was overwhelmed with joy as she spoke to me in the principal’s office and she told me I got a kidney. It was a great day that day,” said Ahmad. Although dialysis is a remarkable scientific development, it is not nearly as effective as a kidney is. Thus, a more long-term solution is a kidney transplant but the wait for a new kidney is a long one.
“I was blessed for 12 years. I was no longer a slave to a [dialysis] machine. But in November 2010, in my third year of college, my kidney failed again. I had to start dialysis again and it was very exhausting to my body,” said Ahmad. His medical situation didn’t just affect him – it affects the family. “It was a very emotional time for my parents. When my little brother was born, he didn’t get much attention because my parents were always worried about me. I just want to be healthy,” he said.
According to Scientific American, a study by Johns Hopkins School of Medicine and published in the , looked at the mortality among 80,000 living kidney donors over the past 15 years, comparing them to people with both kidneys. The study found no increase in mortality in donors once they recover from the operations. This suggests living-donation is very low-risk. And clearly, deceased-donor transplantation have no risks the donor needs to be concerned about.
Kidney donors have the incredible opportunity to give a person one of the few universal things that connects all human beings: health. In addition to the intrinsic rewards associated with kidney donation, donors contribute greatly to the progress of science. “I’m not using my organs after I die so if I can help save lives, why not?” said Brenna Rasmussen, sophomore Biology major and organ donor. With the minimized risk of living-donor transplants and absolutely no risk associated with deceased-donor transplants, everyone should consider being a kidney donor – especially since United Network for Organ Sharing (UNOS) is considering changes to the organ allocation policy that make organ donations more successful.
As the need for organ donations is increasing daily, transplant waiting lists are being greatly scrutinized. Should the kidney transplant list be on a first-come, first-serve basis or should each individual’s situation be evaluated to determine how valuable a kidney will be to them? The United Network for Organ Sharing (UNOS) is the private, non-profit organization which manages distribution of organs according to the transplant waiting lists in the United States, under contract of the government. For the first time in over 20 years, UNOS proposed changes aimed to make better use of the world’s most needed organ – the kidney.
According to the U.S. Department of Health and Human Services, the current kidney allocation system “cannot keep up with current trends in medicine. As waiting times for kidney transplant increase throughout the United States, the need for review of the current system and discussion of possible revisions is great.” With the current policy, kidneys from deceased and living donors are given to candidates primarily based on the length of time the candidate has been on the kidney transplant waiting list. The country is divided into 58 donation regions. When donor kidney becomes available, priority is given to the individual who has been waiting the longest in that particular region. Additional priority is given to children. Other organ donations, such as for hearts or lungs, follow different protocols, taking into consideration life expectancy and urgency while the kidney allocation system does not at this time. The proposed changes to the policy attempt to move in such a progressive direction because UNOS recognizes that the current policy does not necessarily maximize the overall potential of the kidney’s success.
The new system seeks to eliminate bad mismatches of donors and recipients. With the current system, a kidney from a young and healthy individual that might function for decades may be given to an elderly patient with only a few years to live. The opposite is also possible – a kidney from an elderly individual may be given to a young individual who may outlive the kidney and need another transplant. These types of complications can lead to unfulfilled potential success of the kidney. Thus, the most significant part of the proposal is to create a candidate classification index to evaluate both the candidate and the kidney by utilizing a kidney donor profile index (KDPI). The KDPI better characterizes donor kidneys by using kidney quality to estimate the potential function of a donated kidney if it were transplanted in to the average recipient. If the index is implemented, the top 20% of kidneys would be given to the candidates with the highest life expectancy post-transplant, maximizing the potential of the kidney and post-transplant survival. When a resource is scarce, it is important to optimize it. UNOS states, “The proposed changes are estimated to result in an additional 8,380 life years achieved annually from the current pool of deceased donor kidneys while improving access for sensitized candidates and minority candidates.”
Some transplant specialists and bioethicists who are advocating for the policy change emphasize the more specialized matching system to be beneficial because it would be worth the extra years of potential life. Some candidates are difficult to match under the current system due to their health. For example, it is harder to find a kidney for someone with a rare blood type (such as AB-) and the proposed classification index could allow for better organ matching. Furthermore, in several cases, kidneys that seemed promising for a transplant were made not viable due to various problems. Those kidneys could have been transplanted if the allocation system set up a better match. The proposed change is to distribute lower-quality kidneys, such as older or less optimally functional kidneys, to regions with subpar kidney resources to decrease risk of discard into a medical waste incinerator. The policy changes could also decrease the need for a repeat transplant and prevent the current problem of returns to the transplants list, in turn making kidneys more available for first-time recipients. The more effective matching projected outcomes, decreased discard, and overall increased optimization of kidneys could result in more surgeries and procedures for healthcare providers while reducing other expensive hospital visits and dialysis sessions, benefitting both health care providers and patients.
“I agree with the new proposal. I think that younger people who are more active in the community can get a kidney sooner than later and lead an optimal life,” said Ahmad.
Others disagree with the advocates and say the proposal is raising much concern. There will be the ones who are lucky enough to be put in the top twenty percent of the index. Conversely, there will be the other eighty percent who will not be as fortunate and could continue spending years on the waiting list. Age will be a huge factor in deciding who gets a kidney first and this is raising fears of age discrimination. The index and formulas of how the matched recipients will be determined may not account for everything. Furthermore, bioethicists against the policy change are posing questions of ethical justification of the allocation. Who’s to say that it is more important for younger person to get a higher ranked kidney versus a middle aged person? While people are happy UNOS is committed to making a more efficient and fair system, they are wondering about the commitment to increasing supply of the scarce resource. Either way, UNOS is certainly heading in the right direction in its attempts to optimize kidney allocation.
Kidney failure was considered a death sentence not too long ago. Today, treatments such as dialysis are helping people but are very limited in their treatment capacity. Kidney transplants offer the most effective long-term improvement in length and quality of life. The ethics, benefits, detriments, and the public’s consideration of the UNOS kidney allocation proposal revision are now being considered. You may not have any experience or connection to organ donation presently but could in the future. It is our duty to ensure that all humans get the best healthcare treatment. We can do our part by learning about and evaluating organ donation and its associated policies. After public consideration, the policy will ultimately be voted on by the network of Organ Procurement and Transplantation Network by the Department of Health and Services. If the final proposal is approved, its affects will be felt immediately.