The harsh reality is that more than half of kidney transplant candidates over age 60 will die before receiving an organ from a deceased donor, researchers estimate.
That is why such experts as Kapur, Segev and Mikel Prieto, surgical director of the kidney and pancreas transplant program at the Mayo Clinic in Rochester, Minn., are trying to broaden the pool of potential living donors to include adults in their 60s and 70s.
Studies indicate that 10 percent to 20 percent of seniors who need a transplant would find living donors, many among people of their own age, if they looked, Segev said.
Proposed distribution changes
Kidneys from deceased donors are carefully rationed under rules established by the nonprofit United Network for Organ Sharing, or UNOS. Kidneys go to people who have spent the longest time on waiting lists and who are a good match, with provisions made for distributing organs to patients within the same region, when possible.
That method would change under a proposal from the UNOS' kidney transplant committee.
The proposal, released in September, has two main goals, according to John Friedewald, chair of the committee and associate professor of surgery-organ transplantation at Northwestern University Feinberg School of Medicine.
The first is to maintain access to transplantation for everyone on waiting lists, more than 94,000 people currently. The second is to better use the available organs. Slightly more than 7,400 kidneys were harvested from deceased donors in 2011, the last full year for which data are available.
Under the proposed plan, all kidneys from donors who have died would be ranked, based on their expected survival after implantation. (All kidneys do not function equally, and the age and health condition of a donor can affect an organ's longevity.) A similar ranking would be done for potential recipients. Then, the top 20 percent of kidneys — those with the greatest expected longevity — would be matched to patients expected to live longest after receiving the organ.
No system of formally ranking patients by likelihood of survival currently exists.
The approach favors younger patients with longer life expectancies, but computer simulations of the proposal show that "more than half of kidneys would still go to candidates older than 50," Friedewald said.
For the 80 percent of patients not placed in the top tier, the current allocation system would remain largely intact. However, kidneys with the lowest expected survival would be distributed more widely across the country, a move that could help older patients.
At present, more than 2,600 less-than-optimal kidneys from donors who have died are discarded each year, in part because surgeons prefer higher-quality organs but also because the current allocation system does not factor in potential recipients' age.
UNOS expects further refinements before a change would go into effect.
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.