Kidney-transplant rationing is harsh, but necessary

The following is an editorial from the online version of the Union-Bulletin, from Walla Walla, Washington. Due to the ongoing shortage of kidneys available for donation, “new rules have been established to the nation’s (USA) kidney transplant system that favor patients who have a better shot at obtaining a longer-lasting organ.” What do you think? Given the circumstances, do these new rules make the best of a less than ideal situation? Note the sentence I highlighted near the bottom of this article.

Editorial – Kidney-transplant rationing is harsh, but necessary

Kidneys and other human organs that can be transplanted are a scarce commodity.

Yet, it’s difficult for society to take such a hard, cold view of rationing these lifesaving organs harvested from those who have died.

Everyone who needs a kidney transplant desperately wants one — regardless of age, current health or chances of survival. The heck with the odds, they want to live.

And who can blame them?

But starting this week the desire to live won’t be enough to secure a kidney for transplant. New rules have been established to the nation’s kidney transplant system that favor patients who have a better shot at obtaining a longer-lasting organ.

“Not everyone’s going to get the same benefit out of a kidney transplant,” said Dr. Matthew J. Ellis of Duke University Medical Center. “We’re trying to apply common-sense principles to address those issues.”

The goal — getting the maximum benefit out of a scarce resource — does make sense.

However, that will be of little comfort to those on the transplant waiting list who will be skipped over in favor of a recipient who is expected to live longer. It will be a devastating blow to them and their families.

While it will be difficult to pass over those in need of a transplant, the numbers show it has to be done. The gap between those who need new kidneys and available kidneys continues to widen. More than 100,000 people are on the national waiting list for a kidney, while fewer than 17,000 transplants are performed each year.

To this point, the length of time a person has been waiting for a kidney has been the main factor in deciding who gets the next available kidney.

Now, the best kidneys — based on donor age and medical history — will go to patients who are expected to survive a transplant the longest.

It is too bad it has come to this, but there are simply not enough kidneys available for transplant.

More than 6,000 people in America die annually while awaiting an organ transplant.

Based on the number of traffic deaths alone, there would be enough kidneys and other organs available if more people agreed to be donors when they die.

The list for organ donations is growing five times faster than the rate of organ donations.

That could change if more people become organ donors.

But until that occurs, establishing priorities based on long-term survival is the appropriate approach.

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2 thoughts on “Kidney-transplant rationing is harsh, but necessary

  1. John Sisco

    Hi Russ.
    This is an interesting perspective regarding rationing. Personally, I disagree with the aurhor’s analysis. First of all, only God knows who will survive and for how long! Frankly, I feel the writers point is fallacious that those expected to live longest should receive the first transplant. Secular logic would suggest that those expected to die first should receive their transplant first. If the medical profession’s assessment is correct and the recipient dies then they can simply re-use the kidney for the next donee in line. This logic would suggest that more people would benefit! Then again, what does logic have to do with the way mankind operates?
    That said, perhaps the fairest way to ration gently used organs would be to have a lottery of all patients in need of say a kidney. Then, every person in the kidney pool would have some hope. As you are aware this would be the hope of being assigned. Rather than the ex-dividend date, which as you know is when many assignments occur, it may be considered the ex-kidney date!! Or, in this case, the pro-kid date!
    Be well Russ,

    Blessings,

    John

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    1. Russ Sawatsky

      Love the option analogy, John. As for the ethics of this particular path, I’m not sure I’m in a position to say. It’s a nationwide (US) policy. I am aware that, in Canada, there are people who are judged to be unsuited to receive a transplant because of their health. That is, they are not healthy enough to cope with the surgery. Of course, health and age are often related.

      As to your suggestion that the kidney transplanted into one person who subsequently dies being transplanted into another person, that is something I’ve never heard before. I wonder whether such kidneys are considered healthy enough to thrive in a third body. Out of curiosity, I will try to find an answer.

      Grace and peace,

      Russ

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      Reply

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