Determining Priority to Kidneys

New rules for determining priority for organs may reduce the likelihood of older patients receiving kidneys.  See Alan Zarembo, With kidney transplants, a question of how to ration life, LA Times, Nov. 5, 2006, which explains:

With little public scrutiny, transplant doctors and administrators are discussing who should receive life-extending kidneys — and support is growing for a national system that would favor the young.

The United Network for Organ Sharing, which oversees transplantation for the federal government, has already given patients younger than 18 an advantage. Last year, it moved them to the front of the line for high-quality organs from donors younger than 35. * * *

From a statistical standpoint, kidneys are being squandered.

Nearly everybody, at least up to age 70, lives longer with a transplant than with dialysis. But the young gain the most extra years of life. In the mathematics of transplantation, they have the potential for the most “net lifetime survival benefit.”

Maximizing the benefit, in many respects, is a harsh calculation.

Race, weight, disease type and length of time on dialysis all count. Blacks, for example, tend to survive longer on dialysis than whites and Asians, but do less well with transplants. Obese patients tend to live longer on dialysis than normal-weight patients, but not as long with transplants.

A purely utilitarian equation would favor young, trim whites and Asians who have been on dialysis less than a year.