Having patients wait their turn for a transplant may not be the best way to allocate some donated kidneys.
When someone recruits a family member or loved one to donate a kidney, the donor may not be a compatible match, but a proposed database could give patients in this scenario a good shot at a quick transplant by matching them with other living donors.
Currently, transplant doctors balance three considerations when determining who gets a donated kidney: the recipient?s time spent on a United Network of Organ Sharing waiting list, critical need and whether an earlier transplant will prevent their need from becoming critical.
“With domino-paired donation, all three of these ethical tenets are satisfied,” said Dr. Robert A. Montgomery, chief of transplantation at The Johns Hopkins University School of Medicine. “You?re taking advantage of that organ that?s already been offered by someone like a brother.”
The neediest patients are served, since in many cases patients with incompatible donors suffer disproportionately long waiting times, he said. Most patients receiving dialysis grow worse while waiting for a kidney. Someone on the list benefits by receiving the last kidney in the chain.
To date, Hopkins surgeons performed two triple- and one double-kidney transplant using the domino-pairing technique. Three altruistic donors ? those with no connection to patients awaiting transplant ? were able to benefit eight recipients, Montgomery said.
The program works because incompatible donors might not willingly give up a kidney if they were not assured the surgery would result in benefits to their loved one. Keeping those potential donors in play by cross-matching several recipients allows doctors to perform more transplants than they otherwise would.
A healthy person has two kidneys that remove waste products, drugs and excess fluids from the body and produce hormones that regulate blood pressure as well as an active form of Vitamin D, according to the National Kidney Foundation. Most people can lose or donate one kidney without suffering adverse health effects.
Most donor kidneys come from cadavers and are distributed according to guidelines meant toensure that organs are distributed in an equitable, ethical and medically sound manner.
Since the first altruistic donor came forward in 1998, 302 altruistic kidney transplants have been performed in the U.S., according to UNOS.
Using a computer simulation, Montgomery calculated 583 transplants could have been achieved if the domino-donation model had been in place nationwide to handle these altruistic donors.
Because there is no database of this kind, Montgomery said altruistic donor kidneys often end up on an Internet donation site or at transplant centers subject to variable ethical criteria.
The process may need a change in the federal law, which could be interpreted to bar recruited donations under these conditions, Montgomery said. Some list administrators might say promising a benefit to their loved one is an unethical enticement to keep a donor in the system.
