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Poor Distribution Loses Thousands Of Transplant Kidneys

Cheryl Clark, for HealthLeaders Media, July 1, 2010

If the nation could expedite its system for distributing kidneys of lower quality— but which are still viable for transplant— thousands of organs now rejected and discarded could be saving lives rather than be tossed out because too much time was wasted trying to find a transplant center that would accept them.

That's because there's just a few aggressive transplant centers in the country, those with the sickest patients as well as those in areas with the worst donor kidney shortages, that accept those less-than-perfect but still functional organs, say researchers at Johns Hopkins University School of Medicine.

As these somewhat inferior "less than perfect" organs are offered and rejected, center to center, by the time they are offered to a willing center, it is too late. Inferior organs are those from older donors, those with a history of smoking, hypertension, diabetes, stroke, hepatitis C, or IV drug use history, but are healthy enough that in transplant, they can save lives, and are a better — and much cheaper — alternative to dialysis.

In an article in the American Journal of Transplantation, Dorry Segev, MD, Johns Hopkins associate professor of surgery, and colleagues developed a system to conservatively identify these lower quality but still viable organs that would likely be wasted. He proposes launching a different distribution system that would offer just those inferior organs first to the centers that need them the most.

Alternately, after they were rejected by their local transplant centers, these lower quality organs would be offered to all centers so those centers willing to accept the organ would get them much faster. Each hour a kidney stays outside the body reduces the transplant's success and lengthens the patient's recovery time.

"Every year, 5,000 patients die waiting for a transplant and another 2,000 become too sick to transplant," Segev says. His research found that of 39,035 adult kidneys recovered from donors between 2005 and 2008, 10,410 were held outside the body for more than 36 hours, and of those, 9,262, eventually discarded.

He and colleagues developed a Probability of Discard or Delay or PODD scoring system to determine which organs might have been used that would otherwise be discarded. And if it had been in place those four years, he says, patients would have received transplant kidneys before the organs had further deteriorated, which would have improved the patients' prognosis after transplant.

"Of the 10,400 kidneys, it's likely that 1,200 we would have been able to have been transplanted faster and thus, 1,200 people would have had better outcomes. Somewhere between another 500 to 1,000 would have been distributed in a more efficient way that they would have been used instead of discarded."

The authors wrote that their "proposed PODD measure identifies the kidneys that are of least interest to most transplant centers," Segev wrote in the journal. "We propose that those hard-to-place kidneys, which we have already shown are poorly served by the current system, should be distributed through an alternate system in order to direct these kidneys to centers that are most likely to accept them, as demonstrated by past acceptance of similar organs."

It would also reduce the administrative burden on the United Network for Organ Sharing, the databank that distributes kidneys nationally, and "allow the organs to be transplanted with reduced CIT (cold ischemic time)."

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