THURSDAY, Aug. 3, 2006 (HealthDay News) -- Kidney transplants are common, safe and lifesaving, but they also provide a window into the medical and ethical dilemmas associated with organ transplants in general.
In the United States alone, more than 63,000 patients are waiting for a kidney, according to the National Kidney Foundation. The kidney waiting list of the United Network for Organ Sharing currently increases at a rate of 20 percent a year, and the list will be 100,000 to 150,000 patients long by the year 2010.
Three reports and an editorial in the Aug. 1 issue of the Annals of Internal Medicine deal with the problems of increasing the organ supply and one medical danger facing live kidney donors.
In the first study, Spanish researchers report on the success of transplanting kidneys from people who die from heart attacks outside the hospital. They suggest this approach can be used to increase the supply of transplantable kidneys.
In the United States, transplant donors are either living donors or those who have been declared brain dead. However, in Spain, kidneys are being donated by people who die of cardiac arrest outside of the hospital. In the study, researchers looked at the outcomes of 584 patients who received kidneys from live donors and compared them with 320 patients who received kidneys from donors who died outside a hospital.
They found that one-year and five-year survival rates were similar. Based on these findings, the researchers believe that kidneys from deceased donors can be used to increase the supply of kidneys for transplantation.
One expert thinks this method of obtaining donor organs might work in selected situations.
"The number of patients who are waiting for kidney transplants and many other organs is increasing far greater than the supply," said Dr. H. Albin Gritsch, surgical director of the Kidney Transplantation Program at the University of California, Los Angeles. "That's the impetus for looking at other ways of obtaining organs."
Gritsch noted that time is an important consideration. "One of the problems is the time in getting permission from the donor families," he said. In addition, the organ must be harvested quickly for it to be useful, he added.
"All this adds another layer of complexity," Gritsch said. "There is also a fear on the part of some people that doctors would use this method to increase the organ supply as opposed to benefiting the patient in trauma."
Another expert thinks that obtaining kidneys this way will be limited, but is worth trying.
"This can't work in every place," said James F. Childress, from the Institute for Practical Ethics and Public Life at the University of Virginia and author of an accompanying journal editorial. "But in some urban areas that have good systems, it is worth at least a pilot study to see if this could be done consistent with public values," he said.
In the second study, Canadian researchers reported that among live kidney donors, there is a significant risk of developing high blood pressure. High blood pressure can lead to heart disease and can damage the remaining kidney, the researchers noted.
In their study, the research team looked at 48 other studies that included 5,145 kidney donors. They found that five years after donation, the blood pressure of kidney donors was 5 mm Hg higher than expected with normal aging.
"These results must be interpreted in the overall context of living kidney donations," said lead researcher Dr. Amit X. Garg, from the division of nephrology at the London Kidney Research Unit in London, Ontario, Canada. "Living donation is such a positive procedure that this shouldn't detract from people coming forward to become donors, because that would be a terrible thing."
Garg noted that donors need to be informed of the risk and monitored so that any increase in blood pressure can be controlled to minimize the dangers. "For people who donate a kidney, it is essential that they continue follow-up with their family physician to make sure they remain in good health," he said. "This risk should not discourage people."
Gritsch believes that living donors need to make informed decisions when thinking about donating a kidney. "The fear in the transplant community has always been that you are taking someone who is healthy and putting them at risk," he said. "There is always a risk in donating a kidney."
"Our job is to make sure the donor knows the risks," Gritsch added.
Childress thinks more study is needed to determine the effects of donating a kidney. "We don't know enough about the long-term impact of kidney donation from living donors," he said. "Yet living donors are a rapidly growing area for obtaining organs."
In the third report, Dr. David Steinberg, of the Lahey Clinic in Burlington, Mass., expressed his concern with Web sites and other advertising that attempts to match those in need of a kidney transplant with live donors.
The problem, according to Steinberg, is that this method bypasses the usual criteria for transplantation, which is giving an organ to the patient most in need when the transplant is available, and replaces it with a system where people find someone who wants to donate a kidney for other than medical reasons.
"Transplantation is a battlefield between two ethical concepts," Steinberg said. "One is utility, which means that you want to get as many organs as possible and do the most good with the organs. And the other is equity, which means that you want to be as fair as possible in distributing organs," he said.
Steinberg noted that for kidneys supplied from people who have died, there is a national system, and people are put on a waiting list, which determines need by factors such as time on the list, being a child, medical urgency and match between organ and recipient.
"Kidneys are not just given out. A lot of thought goes into the fairest way to do this," he said.
"But when you have this parallel public system where people go on the Internet, it doesn't necessarily work out that the person who has waited the longest gets the kidney, it doesn't work out that the person who is sickest gets a kidney," Steinberg added. "It may work out that the person who is more media savvy and sophisticated has a better chance of getting a kidney."
Steinberg suggested that living donors who decide to donate an organ to a particular person should be informed about other people who may need the organ and perhaps deserve it more, because they have been waiting longer or are sicker. This, he believes, will make private living organ donation fairer.
Telling private donors about other people in need of an organ after they have selected a recipient is like "bait and switch," said Dr. Jeremiah Lowney of Boston, the medical director and co-founder of MatchingDonors.com, an Internet site for live organ donors. "It can be psychologically damaging to the donor," he added.
Lowney does think that potential donors should be informed ahead of time that they can donate an organ to someone selected on the basis of need or they can select a specific recipient.
More information
The National Institute of Diabetes and Digestive and Kidney Diseases can tell you more about kidney transplants.
