The Grapevine

3,631 Donated Kidneys Discarded In 2016, JAMA Study Finds

More than a month after President Donald Trump signed an executive order to help the 5,000 people annually dying due to delays in kidney transplantation, a new study highlights a potential reason behind not finding a match. Researchers said it could be because thousands of kidneys are discarded by hospitals every year.  

The study was published on August 26 in JAMA Internal Medicine titled “Disparities in Acceptance of Deceased Donor Kidneys Between the United States and France and Estimated Effects of Increased US Acceptance.” The aim of the decade long comparison between the utilization of donor kidneys in the United States and France was to identify irregularities preventing kidneys from reaching patients in need. 

New Study Reveals Figures

According to comprehensive data from a French registry, 29,984 kidneys were retrieved from 15,500 deceased donors between 2004 and 2014. Of these, 27,252 were successfully transplanted in patients, while 2,732 or 9 percent were thrown out. 

The U.S. cohort included 156,089 kidneys that could be potentially used for transplantation from 78,517 dead donors over the same decade ( 2004 and 2014). Among them, 128,102 were used for the purpose of kidney transplantation, whereas 27,987 or 17.9 percent were discarded.

The number only increased post the study. As of 2016, 3,651 kidneys were discarded and the percentage of kidneys discarded rose to 20 percent. Researchers realized there is a problem with the way the American healthcare system allocates kidneys.

Mean Age of Donation 

As a result of comparing practices in two countries, they arrived at the mean age of the donors. In France, the demand was met by the acceptance of kidneys from donors with an average age of 56. Despite the lower-quality as they could have belonged to people who suffered from diabetes or hypertension, quality of life can improve significantly. Nevertheless, accepting such kidneys will relieve the 93,000 people on the waitlist of the United States.

kidney Kidney failure can be prevented by diagnosing the condition before it progresses too far. Photo Courtesy of Pixabay

The mean age of kidney donors in the U.S. was 39 since some of the hospitals want to keep up a superficial five star rating to reflect success rates. However, the complications that arise after the transplant can be managed better than dialysis. The only drawback of using a kidney with comorbidities is that the patient takes longer to recover and the medical cost is higher.  

In Europe, the older kidneys that are not the best fit for younger people are transplanted in older patients. But the medical practitioners in the U.S who are more concerned with quality perform biopsies to analyze the organ’s condition, which are not always accurate. Biopsies are not conducted on donated kidneys in Europe, hence they are more open to utilizing the organ for its beneficial properties.

Changes in Policy  

Such changes in the policy are required since more than 37 million Americans or 15 percent of the adult population suffered from chronic kidney disease in 2017, according to Centers for Disease Control and Prevention (CDC).

Researchers suggest redesigning the allocation system. "As most of the wait-listed kidney transplant candidates are on costly dialysis, it would also allow the US healthcare system to achieve enormous savings in the near future," Dr Olivier Aubert, Assistant Professor at the Paristranslational Research Center for Organ Transplantation, INSERM, France, said.

"It is recognized that the overly stringent and restrictive process of monitoring transplant programs in the United States has resulted in many transplant programs taking a risk averse approach," Dr. Ryoichi Maenosono and Dr. Stefan G. Tullius of Brigham and Women's Hospital, said in a commentary attached to the study.

Hospital administration do not want to “lose credentials if their one-year death and graft failure outcomes exceed predicted outcomes," another researcher said in the commentary.