New rules give hope to people waiting for donated kidneys

Posted at 11:43 AM, Dec 05, 2014

ATLANTA — Chardae Sanders received some potentially good news this week from the organization that decides who gets donated kidneys.

Sanders, 28, has been on dialysis for about six years. Lupus, high blood pressure and an infection caused a kidney to fail. The Georgian already received one kidney from a living donor in 2009, but her body rejected it the next year due to a parasite. Working through Emory University Hospital, she’s been waiting for a donated organ ever since. “They said they will call when there’s a match,” Sanders said.

Effective Thursday, changes in the way the waiting list is calculated could work in her favor, including the length of time she’s been on dialysis, her young age and a couple of other factors. There’s hope that call from Emory may come sooner.

Kidneys are a scarce resource.

Fewer than 17,000 transplants are performed a year, and there are 101,954 people who need a donated kidney, according to the United Network for Organ Sharing, or UNOS, the organization that runs the system.

When someone needs a transplant, he or she is placed on a waiting list. Where someone falls on that list depends on a wide variety of factors. These shifted with Thursday’s changes. The hope is that the new criteria will help maximize the benefits from the small pool of donated kidneys available.

Before the changes, people who were waiting the longest would be higher up on the list. Now the healthiest of the kidneys will be offered first to patients whom doctors expect will survive the transplant the longest. The viability of transplant is determined by the age of the kidney and the kidney donor’s medical history.

Of transplant candidates, almost 15 percent are waiting for a second transplant because their bodies rejected the first.

Tonya Saffer, senior health policy director at the National Kidney Foundation, explains: “If you give a 20-year-old a 65-year-old kidney, there is a likelihood the 20-year-old will have to get another transplant at some point. So this fixes that,” Saffer said. “We will be able to make better use of kidneys and not have to re-transplant as many people,”

Reducing those transplants means the number of people waiting for kidneys should then go down.

Other revisions include a shift that helps people who are tough to match because they have higher levels of antibodies that make them not the best candidate for transplantation. They move up on the waiting list.

Minority patients who typically have a blood type of B should benefit from a change in the policy. The policy widens the pool of blood types that would be a match for that person.

The number of years people have been on dialysis will now count toward their time on the waiting list. But the less time someone spends on dialysis the better the chance the transplant will take.

The change in dialysis rules should also help minority patients since studies show as a group minorities and people in rural areas tend to spend more time on dialysis.

There will also be a priority given to living donors. If you gave someone else a kidney and you need one down the road, you will automatically start higher up on the list.

The changes are a big shift, according to Saffer.

“It’s a big deal. I think it is definitely an improvement over what the policy is today,” Saffer said. “No policy is ever going to be completely fair for everyone because there aren’t enough kidneys for everyone who needs one, but this is a step in the right direction to make sure we are reducing organ wastage and trying to increase the number of people getting kidneys.”