Should Kidney Transplants Favor Youth?

September 26th, 2012 by Andrea Bennett

Proposed rule changes could see younger patients receiving organs first.

Brought to you by Liberty Mutual's
The Responsibility Project

The question of who should go to the front of the line for a kidney transplant has long been a source of debate among potential recipients and the medical community.

But a recent NPR article reports that for the first time in 25 years, the rules may change. A proposal from the United Network for Organ Sharing (UNOS) suggests that the kidneys likely to last the longest (usually from younger donors) should go to the recipients likely to live the longest with the organs – who are also often young.

If the proposal were to be enacted, the 20 percent of kidneys expected to last the longest would go to the 20 percent of recipients expected to get the most years out of each organ. John Friedewald of Northwestern University, who chaired the UNOS committee that developed the proposal, says the benefits of such a program would be twofold: More years would be gained from each transplant, with recipients living longer; and the plan would substantially decrease the number of patients who have a transplanted kidney fail while they are still alive, forcing them back onto the waitlist.

Explaining the need for the proposed changes, Friedewald told NPR, “We aren’t maximizing the life benefit from the existing kidney transplants that are available out there.” Right now, kidneys generally go to recipients on a first-come, first-served basis. The problem, Friedewald says, is that kidneys from young, healthy people often end up in elderly, frail recipients while young, otherwise healthy patients often receive organs from older donors.

A “Transplant Trend” chart on the UNOS website dynamically updates the number of Americans waiting for organ transplants. More than 115,000 are on the waitlist for organ donations, including 93,000 waiting for kidneys. Between January and June, approximately 14,000 transplants were carried out.

And while some say it makes good medical and ethical sense to maximize the use of each donated kidney, others worry that the changes could be perceived as discriminatory against older patients. Lainie Friedman Ross, a bioethicist at the University of Chicago, told NPR, “Maybe the 75-year-old doesn’t need a kidney that’s going to go 20 years. But you haven’t given an ethical justification for why you’re going to create this top 20 percent.”

According to NPR, UNOS does not plan on slowing its attempts to revamp the transplant system, proposing more changes in an effort to find a balance between fairness and efficiency. The organization is taking public comments on its proposal for three months before sending a final version to its board of directors.

Is it fair to send younger recipients to the head of the transplant line, or should the system stick to its first-come, first-serve process? Weigh in here.