Are Living Donors Really Getting Their Due?

What Functions do the Kidneys Perform? The kidneys are a pair of bean shaped organs located behind the abdominal organs, and on either side of the spine. They perform the following important functions.

• Filtration of waste products and toxins in the blood
• Excretion of fluid and maintaining the correct fluid balance
• Control of blood pressure
• Production of erythropoietin, a substance that prevents anemia
• Maintenance of the acid base and electrolyte balance of the body.

Types of Donors A person who donates an organ is called a donor and the patient who receives the organ is the recipient. The donor may be a person who has suddenly died and is a registered donor. Such donors are referred to as deceased or cadaver donors. In certain cases, the organ may be donated by a close relative. Such donors are called living donors. Renal Transplant in Brief It is a surgical procedure carried out to place a healthy kidney from a donor who may be either living or dead, into a patient whose kidneys have failed. Features of kidney failure appear only when more than 90% of the function is lost. In such patients, a procedure called dialysis is done, which is an artificial method of filtering the blood of waste and toxins. In patients with end stage renal disease, a renal transplant may help save their life. Compared to dialysis, the quality of life following a renal transplant is better and most are able to return to their earlier lifestyle. How the Kidney Transplant Network Operates Donor organs are matched with potential recipients by a registry containing all the relevant data such as donor list, waiting list of recipients and list of transplant centers. If a registered donor suddenly dies, the registry will be notified and should the organs prove to be a match for a waitlisted recipient, they will be in turn notified to get ready for the transplant procedure. However, the list of patients on the waiting list for a kidney transplant far exceeds the numbers of donor kidneys actually available, leading to constant discussions on how to overcome the organ shortage and in some countries this has lead to organ trade and other unfair practices. In the US, the average waiting time is 3 to 5 years, depending on the blood group. The situation is no different elsewhere in the world too, with prolonged waiting periods to receive a matching donor organ. Promise of Preference for Living Donors - Is it being Implemented? In the US, living donors have been promised that they will get priority access to organ transplant in the future, should they fall sick and need one. Studies conducted by Jennifer Wainright, PhD (United Network for Organ Sharing, or UNOS) and her colleagues determined how promptly living donors received their transplant. To do this, they gathered data from the Organ Procurement and Transplantation Network (OPTN), which contains data on all donors, wait-listed potential recipients, and those who have already received transplants. UNOS is a private, not for profit organization that runs the organ transplant system of the USA, on contract with the federal government. What the Studies Revealed? The highlights of Dr.Wainwright's studies are as follows -

• 210 prior living donors were added to the OPTN renal transplant waiting list between January 1, 2010 and July 31, 2015.
• Data revealed that until September 2015, 167 of the donors got deceased donor transplants, 6 obtained living donor transplants, 2 died, 5 were too sick to undergo the transplant, and 29 were still waiting for their turn.
• The average waiting time to get a cadaver donor transplant for prior living donors was 98 days.
• Only 40.7% of the living donors were on the list before they started dialysis; 68.3% were in inactive status, meaning they were not eligible for organs for <90 days, 17.6% for 90-365 days, 8.6% for 1-2 years, and 5.4% for more than 2 years.
• The average waiting time for prior living donors who were in active status before obtaining priority was 2 days; 67.4% received priority within 7 days after activation, while 15.4% waited between 8-30 days, 8.1% for 1-3 months, 4.1% for 3-12 months, and 5.0% waited for more than a year in active status to get priority.
• After receiving priority, most patients were transplanted quickly, and the median time in active status with priority before deceased donor transplant was 23 days.

According to Dr Wainwright, "We found that most prior living kidney donors on the kidney waiting list are transplanted quickly, but some spend varying periods of time waiting in inactive status. Others wait weeks or months on the waiting list without priority access, which must be requested by their transplant hospital," said Dr. Wainright. "UNOS has eveloped procedures and education that aims to reduce these delays in the future." References :

1. The Waiting List - (http://www.kidneylink.org/TheWaitingList.aspx)
2. UNOS Transplant Waitlist Status - We need your input by February 28, 2014! - (https://www.kidney.org/transplantation/transaction/TC/winter14/UNOS_Committee)
3. The State of U.S. Living Kidney Donors - (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2974389/)
4. Why You May Need a Kidney Transplant - (http://www.emoryhealthcare.org/transplant-kidney/learn-about/why-needed.html)

Source: Medindia

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