“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.
 |
| http://www.organdonor.gov/about/data.html |
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 JAMA The Journal of the
American Medical Association, 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.
 |
| http://theworldaintallsunshineandrainbows.blogspot.com/2013/02/organ-donation-saves-lives-and-i-should.html |
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.
