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Donor Pool Might Shorten Wait for Kidneys

System could make 10 percent more organs available

SATURDAY, Aug. 18, 2001 (HealthDayNews) -- A statistical model for kidney transfers could make more organs available for transplant and save the lives of thousands of people who otherwise might die, says a new research paper from the Stanford University Graduate School of Business.

The researchers believe their system could make 10 percent more kidneys -- or 1,000 to 2,000 of the organs -- available for transplant each year in the United States.

The model was developed by Stefanos Zenios, a business operations researcher at Stanford, along with Dr. Lainie Ross, a medical ethicist and University of Chicago associate professor of pediatrics, and Dr. E. Steve Woodle, a transplant surgeon at the University of Cincinnati College of Medicine.

Here's the basic idea. Often, family members of a kidney patient want to donate a kidney to a loved one but are unable to because they aren't the right blood type.

But the new model proposes that those relatives donate a kidney to a transplant pool and, in return, their loved one moves higher on the transplant waiting list and receives the first kidney that matches him or her.

That could decrease the waiting time for a kidney transplant by as much as 15 percent and improve the survival chances by the same margin, Zenios says.

Each year in the United States, 40,000 people with kidney failure wait for a transplant, but a shortage of kidneys means only about one-quarter of them get a transplant.

Zenios and his colleagues say they spent months devising a statistical distribution system that tries to be fair to all patients. Their plan takes into account such factors as general health, age, blood type and how close the patient is to total kidney failure.

The model did indicate a disadvantage for patients with O-type blood who didn't have anyone to donate a kidney on their behalf. Unlike other blood types, which can match with multiple blood types, people with O-type blood have to be matched with other O-types.

O-type patients who had someone to donate a kidney on their behalf would rise to the top of the O waiting list, while O-type patients unable to bring donors to the pool would have to wait longer, according to the model.

Some kidney specialists have misgivings about the Stanford model.

"My ethical beliefs would advise me great caution in adopting this policy," says Dr. Les Spry, a member of the National Kidney Foundation's public education committee.

He's concerned that no effort has been made to consider the pressure a patient can bring on a family member to donate a kidney.

"Right now, if a patient presses a spouse to donate a kidney, we, as transplant physicians, always have the 'out' that we can tell the patient that their spouse is not a match," Spry says. "Some spouses say they want to donate in front of their loved one, but later, in private, express reservations. If they can donate to a pool, then this 'out' is no longer a potential option."

One of the Stanford research paper's co-authors, Dr. Ross, says the statistical model isn't the ultimate cure for kidney donor shortages.

"This is definitely a way of increasing organ supply, but there are others and some of them cause less harm to healthy donors," Ross says.

Solving the shortage of kidneys or any other transplant organs has to be a multi-pronged approach, she says, but the priority needs to be getting people to sign organ-donor cards and talk to their families about that decision.

Too often, experts say, families refuse requests to remove organs from dead or dying relatives, even though that person signed an organ-donor card. That's why doctors and medical ethicists urge families to discuss organ donation when they're all healthy, instead of having to cope with the issue in the midst of an unexpected tragedy.

"You're not given 30 seconds to start grieving before you're asked this question that you may never have discussed or thought about," Ross says.

What To Do

To read the full research paper on the kidney transplant statistical model, go to the Stanford University Web site.

For information on organ donation, visit the National Kidney Foundation or the Coalition on Donation online.

SOURCES: Interviews with Lainie Ross, M.D., Ph.D., assistant director, MacLean Center for Medical Ethics, and associate professor of pediatrics, University of Chicago, Chicago; and Les Spry, M.D., Lincoln Nephrology and Hypertension, Dialysis Center of Lincoln Inc., Lincoln, Neb.
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