Organ Donation After Death at Old Age is Found Effective

Highlights

• Kidney donation from older people has for long been discarded based on age as a criteria, however, a new study finds that good quality kidneys from older patients can be transplanted successfully.
• The patient and kidney survival rate from patients over 80 years is similar to the rates from people over 50 years.
• The discard rate was found to be more among people over 80 years than among other age groups.

Organ donation can save many lives, helping terminally ill patients. Though the importance of organ donation is well understood, organ donation from older patients has been avoided.

However, a new study by the American College of Nephrology shows that kidneys donated from people between

• 50-59 years
• 60-69 years
• 70-79 years
• 80 years

had similar patient and organ survival rate. This is a landmark study that could now aid in the use of kidney from donors who are at an advanced age.

Organ Donation

Organ donation is when healthy tissue or an organ is transplanted while the donor is alive or immediately after death. Kidney transplant is considered to be the first line of defense when the kidneys of the patient fail or are unable to function properly. However, due to the lack of kidney donors, dialysis is carried out to facilitate removal of waste.

According to The Centre For Disease Control

• 20 million people live with chronic kidney disease
• 600,000 are on dialysis
• 100,000 await kidney transplant
• 16,000 kidney transplants are carried out every year.

The number of kidney transplants that are carried out every year is too few to cater to the increasing demand. A landmark study was carried out by Wolfe RA and colleagues to determine whether patients on dialysis, patients on the waiting list for kidney transplant or patients who undergo kidney transplant had a better prognosis. The study found that patients who had undergone a kidney transplant had a mortality rate that was 48 to 82% lower than patients who were on the waiting list.

Addressing Shortage of Kidney Donors

The number of people who await a kidney transplant is huge, but the number of kidney donors is very small. A considerable number of kidneys are rejected from transplantation citing old age of the donor. Efforts are being made by scientists to determine if such kidneys should be discarded or if they can be effectively used in organ donation.

The study was published in The Clinical Journal of the American Society of Nephrology (CJASN) to determine if quality kidneys should be discarded only because they are from a donor who is older. University of Torino’s Dr. Luigi Biancone and colleagues analyzed kidney transplant from diseased patients that were performed at The University of Turin, during the period from 2003 to 2013.

• 647 kidney transplants were analyzed.
• From donors greater than 60 years
• From donors between 50 to 59 years.
• 5-year patient survival rate ranged from 87.8% to 90.1%
• 5-year patient kidney survival rate ranged from 65.9% to 75.2%

The study also showed that kidney discard rate was similar for people within the age group of 50 to 79 years but the rate of discard was a lot more for people over 80 years of age.

The similar patient and kidney survival rates showed that kidneys need not be discarded based solely on the age of the patient but there are other factors that could determine whether the kidney should be used for transplantation.

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Dr. Biancone added with caution, "The results of this study support the use of extended criteria donors, even donors older than 80 years, but they have to be accurately selected and managed with dedicated protocols."

Organ donation is not only a life saver for patients receiving the organ but it can also provide solace for grieving family of the donor, in the event of donation after a person’s death. It helps family members cope with their loss better as they believe that their loved one continues to live and they also feel better about saving another individual’s life.

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Extending the criteria for organ donation will provide more donor kidneys for transplantation and aid in bridging the gap between the number of people awaiting organ donation and the number of people who have had a successful organ donation. 

Kidney transplantation can now be performed by Robot Assisted surgery that is minimally invasive and results in less tissue damage. This surgical procedure results in less pain after the surgery. Scientists have identified 13 genes that act as biomarkers for kidney fibrosis within three months of a kidney transplant, these factors will aid in identifying the survival rates after a kidney transplant.

Studies such as these that re-visit organ donation beliefs and criteria will provide good quality kidneys that were earlier discarded from use, bringing hope to many people who await their turn at a kidney transplant.

References:

1. 4 Facts You Need to Know About Kidney Transplants and Dialysis - (https://health.clevelandclinic.org/2014/07/4-facts-you-need-to-know-about-kidney-transplants-and-dialysis/)
2. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. - (https://www.ncbi.nlm.nih.gov/pubmed/10580071)

Source-Medindia