By now you have probably heard of the national proposal to change the way kidneys are allocated – bypassing the traditional transplant waiting list and matching kidneys by age rather than length of time spent on the list. The topic has sparked heated debate in the kidney community and beyond. Our founder, Ken Kleinberg, recently wrote a letter in response to an editorial on kidney rationing in the New York Times. Here is the original editorial followed by Ken’s letter.
Editorial in the New York Times, Transplants and Rationing
Published: February 27, 2011
The number of kidneys available for transplants falls far short of the need, so there is no choice but to ration them. An emotionally difficult proposal to change the first-come-first-served transplant system makes good sense.
There are nearly 90,000 people on waiting lists to receive kidney transplants, and in 2009 there were only some 10,400 kidneys from dead donors to give them. And about 6,300 kidneys were transplanted from living people who donated one of their two kidneys and usually specified the recipient.
Currently the kidneys from dead donors are provided, through an organ procurement and transplantation network, to people who have been waiting the longest. That may seem fair since many transplant candidates wait for years, and some die while waiting.
But the system has serious shortcomings. Some elderly recipients get kidneys that could function far longer than they will live and that could have done more good for a younger recipient. Some younger recipients get kidneys that will fail and will need to be replaced, using up another scarce kidney.
These problems could be eased through a proposal under consideration at the transplant network to better match the likely longevity of the patient with the likely functional life of the kidney.
The patients and kidneys would each be graded separately. About 20 percent of the kidneys predicted to have the longest functional lives would be provided to the youngest and healthiest patients. The other 80 percent of kidneys would go to patients who are no more than 15 years older or younger than the donor.
The approach seems likely to make it harder for elderly people to get a kidney. But when kidneys are already scarce — and apt to get scarcer as much of the population ages and sickens — it is a rational choice.
UKRO Founder’s Response
March 4, 2011
A discussion on how best to distribute the limited number of kidneys available for transplantation is appropriate, but this will not resolve the problem. Quite simply, too many people have kidney disease—nearly 30 million in the United States alone—and millions more are at risk. Only research can hasten the discovery of more effective treatments for kidney-related diseases, and in the process diminish the growing need for transplants.
The enormity of human and economic losses from kidney disease cannot be overstated. Nonetheless, kidney disease research remains a low priority nationally and is chronically under-funded. Bringing kidney research to the top of the public mind—like AIDS, cancer, heart disease, etc.—can help make vital funding a national imperative.
Kenneth Kleinberg, President, UKRO