New U.S. Kidney Allocation Policy Will Enable Some to Shorten Wait

A new U.S. kidney allocation policy went into effect on October 30th that will enable some patients in need of a kidney transplant to shorten their wait by agreeing to accept a cadaver kidney from an older or less healthy donor.

While kidneys that don't meet the standard criteria have been used successfully and may particularly benefit patients at higher risk of death or severe complications on dialysis, the tradeoff is that these kidneys may not function as well or as long.

The way the new system will work, kidneys retrieved from what are being called "extended criteria" kidney donors will be offered exclusively to patients who have notified their transplant center of their willingness to accept such an organ.

These "extended criteria" kidney donors will be defined as:

• A donor who has died at age 60 or older.
• A donor who has died between the ages of 50 and 59 who had at least two of the following conditions:
  • History of hypertension (high blood pressure).
  • Creatinine level of greater than 1.5 (a creatinine test measures how well a kidney is functioning, with the normal range 0.8 to 1.4).
  • Cause of death was from a cerebrovascular accident (stroke or aneurysm).

As under the standard kidney transplant system which remains in place, a kidney retrieved from an "expanded criteria" donor will be offered first to a patient who has agreed to accept such a kidney and has a nearly identical immune system match. Beyond that, "expanded criteria" kidneys will be distributed solely on the basis of waiting time to patients who have agreed to accept them, offered first to patients in the area where the donation was made, then in the surrounding region, and finally nationally.

An important point, however, is that patients who agree to accept "expanded criteria" kidneys will also remain on the standard kidney transplant waiting list, and would be eligible for a kidney from a younger or healthier donor if such a kidney became available first.

A spokesperson for the United Network for Organ Sharing (UNOS) said the manner in which this new system will be implemented is expected to vary from transplant center to center, and said patients interested in this option should contact their center and inquire about having the necessary change made in their waitlist status.

"It is essential that you discuss your individual situation with your transplant team," a UNOS spokesperson said. The network said that in considering whether to be listed as willing to accept an "expanded criteria" kidney, a patient may want to discuss with their physician:

• "Significant problems you may be experiencing with your dialysis treatment;
• "Whether or not you may face a shorter life expectancy while on dialysis; or
• "If you are likely to suffer major complications while on long-term dialysis."
  

Other sources: UNOS