Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Survival matching should be used to allocate donated kidneys to transplant recipients

18.03.2011
U-M researcher supports proposed concepts for changing how kidneys are allocated, in commentary published in New England Journal of Medicine

Providing kidney transplants to patients with the best probability of longer survival would reduce repeat transplant operations and improve life span after kidney transplant, says a U-M researcher in a commentary published in the New England Journal of Medicine March 16.

Alan B. Leichtman, M.D., professor of Internal Medicine at U-M and his co-authors endorsed new concepts designed to improve kidney allocation. These concepts were circulated in February by the Organ Procurement and Transplantation Network (OPTN). The OPTN is the federal contract that oversees solid organ recovery and allocation in the United States.

"We strongly support the concept of rank ordering donated kidneys based upon their potential post-transplant survival, and matching that survival to that of waitlisted kidney transplant candidates," says Leichtman, the commentary's lead author.

"The current deceased donor kidney allocation system allows distribution of kidneys with very short potential survival to candidates with long expected survival. Candidates with long potential lifetimes that received kidneys with short expected survival have twice the repeated transplantation rate than similar recipients who received organs with a longer expected survival rate."

The current U.S. deceased donor kidney allocation system relies primarily upon how long a candidate has been waiting for an organ. However, systems for liver and heart transplantation allocation are based upon candidate medical urgency. The lung allocation system allocates organs based upon a mixture of medical urgency and expected one-year post-transplant survival.

The Organ Procurement and Transplantation Network has released for public comment three proposed concepts for deceased donor kidney allocation.

Using a Kidney Donor Profile Index to rank deceased donor kidneys according to the length of time that the kidney would be expected to function in an average kidney transplant recipient.
Allocating the 20% highest quality kidneys to the 20% of candidates with the longest expected post-transplant survival.
Allocating the remaining 80% of kidneys such that candidates who are within 15 years (older or younger) of the donor's age have highest priority.

Because of the current system and the aging of the candidate pool, post-transplant life span following kidney transplantation in the United States has declined on average by 18 months since 1995, Leichtman says.

The authors say that computer simulations based on the current donor pool suggest that more than 35,000 years of post-transplant survival are lost each year under the current system. Additionally, more than 10,000 years of incremental post-transplant survival -- extra years of life that would not have been achieved without the benefit of transplant – also are lost each year.

"We are wasting hundreds of thousands of potential years of life," Leichtman says. "The proposal for survival matching as described in the concept document has the potential to reclaim many of these lost years of life, and therefore warrants serious consideration."

The authors also support using the proposed Kidney Donor Profile Index. The new index provides a more granular and accurate survival estimate for organs.

"We suspect that utilization rates of shorter-lived kidneys will increase with accurate information about their survival potential and reduced opportunity for potentially short-lived candidates to be allocated kidneys with long estimated post-transplant survival," the authors wrote.

About 80,000 people are listed nationwide for a kidney transplant. Demand continues to increase, some of it driven by an unnecessarily high rate of repeat transplantations because kidneys and recipients weren't well matched, says Leichtman.

Kidney transplants are the most common transplants done at the University of Michigan Transplant Center and nationwide. But more than half of those who get wait-listed for a kidney transplant in the U.S. never receive a transplant.

"The lost potential life years, and the increase in the waiting list resulting from an unnecessarily high rate of repeat transplantation are intolerable consequences of the current kidney transplant allocation system," Leichtman says. "There likely are further opportunities for improvements to the proposed system, but the core proposals presented in the concept document, adoption of the KDPI and survival matching, warrant the strongest endorsement and the earliest possible implementation by the kidney transplant community."

Public comment is open until April 1 on the proposed concepts. Comments can be e-mailed to kidneypolicy@unos.org.

Journal citation: 10.1056/NEJMp1102728

Additional authors: Robert A. Wolfe, Ph.D., professor emeritus in the University of Michigan School of Public Health and Keith P. McCullough. M.S. Both Dr. Wolfe and Mr. McCullough are investigators at the Arbor Research Collaborative for Health in Ann Arbor, Mich.

Mary F. Masson | EurekAlert!
Further information:
http://www.umich.edu

More articles from Health and Medicine:

nachricht Second cause of hidden hearing loss identified
20.02.2017 | Michigan Medicine - University of Michigan

nachricht Prospect for more effective treatment of nerve pain
20.02.2017 | Universität Zürich

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Breakthrough with a chain of gold atoms

In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport

In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport

Im Focus: DNA repair: a new letter in the cell alphabet

Results reveal how discoveries may be hidden in scientific “blind spots”

Cells need to repair damaged DNA in our genes to prevent the development of cancer and other diseases. Our cells therefore activate and send “repair-proteins”...

Im Focus: Dresdner scientists print tomorrow’s world

The Fraunhofer IWS Dresden and Technische Universität Dresden inaugurated their jointly operated Center for Additive Manufacturing Dresden (AMCD) with a festive ceremony on February 7, 2017. Scientists from various disciplines perform research on materials, additive manufacturing processes and innovative technologies, which build up components in a layer by layer process. This technology opens up new horizons for component design and combinations of functions. For example during fabrication, electrical conductors and sensors are already able to be additively manufactured into components. They provide information about stress conditions of a product during operation.

The 3D-printing technology, or additive manufacturing as it is often called, has long made the step out of scientific research laboratories into industrial...

Im Focus: Mimicking nature's cellular architectures via 3-D printing

Research offers new level of control over the structure of 3-D printed materials

Nature does amazing things with limited design materials. Grass, for example, can support its own weight, resist strong wind loads, and recover after being...

Im Focus: Three Magnetic States for Each Hole

Nanometer-scale magnetic perforated grids could create new possibilities for computing. Together with international colleagues, scientists from the Helmholtz Zentrum Dresden-Rossendorf (HZDR) have shown how a cobalt grid can be reliably programmed at room temperature. In addition they discovered that for every hole ("antidot") three magnetic states can be configured. The results have been published in the journal "Scientific Reports".

Physicist Dr. Rantej Bali from the HZDR, together with scientists from Singapore and Australia, designed a special grid structure in a thin layer of cobalt in...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Booth and panel discussion – The Lindau Nobel Laureate Meetings at the AAAS 2017 Annual Meeting

13.02.2017 | Event News

Complex Loading versus Hidden Reserves

10.02.2017 | Event News

International Conference on Crystal Growth in Freiburg

09.02.2017 | Event News

 
Latest News

Switched-on DNA

20.02.2017 | Materials Sciences

Second cause of hidden hearing loss identified

20.02.2017 | Health and Medicine

Prospect for more effective treatment of nerve pain

20.02.2017 | Health and Medicine

VideoLinks
B2B-VideoLinks
More VideoLinks >>>