New England Transplant Centers Offering Imperfect Organs

June 5, 2005

BOSTON (AP) -- Gloria Daise was stunned last year to learn that the wait for a transplant kidney averaged five to six years. But in April, a surgeon gave her another option: a shorter wait if she accepted a less-than-perfect organ.

Transplant centers in New England and Michigan, where kidney shortages are acute, have been drawing up lists of volunteer recipients willing to use kidneys that come from donors who are older or have risk factors.

Brigham and Women's Hospital, where Daise was seeking her transplant, has about 260 people on a list seeking kidneys from ideal donors who are young and healthy.

Now, as part of a three-year study, the hospital has a list of 33 people willing to accept the "extended-criteria" kidneys from donor who were older than 60 when they died, or were over 50 and had risk factors that might have damaged their kidneys.

The study, which will document how the transplanted organs perform, stems from concern among surgeons that too many of these kidneys, which typically don't last as long as those from younger and healthier donors, are going to waste.

Surgeons argue that the organs could be fine for older patients, who have a greater risk of dying while on dialysis, whose expected lifespans are shorter, and who account for more and more people on organ waiting lists. Surgeons also offer them to patients who don't respond well to dialysis.

Daise wasn't sure she wanted one of the extended-criteria kidneys, but decided to sign up as she considered how much of her life she was missing with her five hours of at-home dialysis each day.

The new lists have shorter waiting times -- six months to two years -- depending on the blood type and other factors, surgeons said.

Such organs "don't last as long as regular kidneys, but they do last a significant amount of time," Dr. George Lipkowitz, director of transplantation at Baystate Medical Center in Springfield, told the Boston Sunday Globe.

"I got frustrated taking very good young kidneys and putting them in 70-year-old patients," Lipkowitz said.

Twenty centers are participating in the study, which the U.S. Department of Health and Human Services is funding. The study will be completed in February.

Early results show that New England transplant centers have reduced the percentage of discarded extended-criteria kidneys from 40 percent to 33 percent over two years, said Dr. Francis Delmonico, medical director of the New England Organ Bank, which coordinates regional donations.

The network adopted a policy 2-1/2 years ago that requires transplant centers to offer certain patients the extended-criteria kidneys, but implementation is spotty and the national rate for discarding kidneys remains at 40 percent, Delmonico said, who is also president-elect of the United Network for Organ Sharing, which runs the nation's organ transplant system

Smaller studies have found that 80 percent of regular kidneys last at least three years after the transplant, while 50 to 70 percent of extended-criteria kidneys last that long. In the New England and Michigan study, 88 percent of 228 extended-criteria kidneys transplanted were still working three months after surgery.

Last year, 21,626 kidney patients were taken off waiting lists, including about 15,000 who received transplants. Another 3,767 patients died while waiting, according to the Organ Procurement and Transplantation Network, which is overseen by the United Network for Organ Sharing. But 27,299 new patients enrolled, a net gain of 5,673 in 2004 alone.

Some surgeons are experimenting with other types of marginal organs. UCLA, which has been trying an alternative heart transplant program, released findings in April that 60 percent of patients given imperfect hearts were alive five years after their transplant, compared with 76 percent of patients who received regular organs.

Not all patients want the extended criteria organs. Massachusetts transplant surgeons said 15 to 20 percent of the kidney patients refuse to put their names on the alternative lists.

Kathie Tessier, 64, told Lipkowitz not to put her name on Baystate Medical Center's alternative list, even though she was an ideal candidate.

"I have some other health issues, and I didn't want to take a chance on something that's not perfect," she said.

Copyright © 2005 by The Associated Press.

This article posted July 16, 2005.