Living donors cut kidney shortage

USA Today (Society for the Advancement of Education), Feb, 1996

The demand for organ transplants continues to outpace the supply and remains the major barrier to transplantation for thousands of Americans. A study by surgeons at Washington University School of Medicine shows that the severe shortage of kidneys - nearly 30,000 individuals are on the national waiting list - could be alleviated if more medical centers would transplant kidneys from living, but biologically unrelated donors, such as spouses or friends.

Today, most transplanted kidneys come from cadavers. These undergo extensive tissue typing and are allocated to recipients with the closest genetic match. However, genetic tissue matching may not be necessary for a successful kidney transplant, the surgeons say. Kidneys donated by spouses or friends - although they don't match genetically - function better and last longer than kidneys from cadavers, they report.

"The number of people waiting for kidney transplants continues to increase each year while the number of cadaver donors has remained virtually stable," notes Jeffrey Lowell, a transplant surgeon and the study's lead investigator. "By expanding the donor pool to include more living, unrelated donors, we may make a dent in the lengthy waiting list."

Due to the severe shortage of donor kidneys, transplant surgeons gradually have expanded their criteria for evaluating cadaver kidneys to include older donors and those with certain medical conditions, such as high blood pressure and mild-to-moderate atherosclerosis. The expanded donor pool means more kidneys are being transplanted, but also has contributed to a lower success rate of cadaver kidney transplants.

In contrast, living kidney donors must undergo a rigorous evaluation and only the healthiest individuals are considered. Such close scrutiny has contributed to the high success rate of living donor transplants. These living donors have "perfect kidneys," Lowell says. "They are the healthiest of the healthy and we know they don't have other illnesses."

Other factors give kidney transplants from living donors an edge over those from cadavers: * Surgery can be scheduled at an optimal time for both the donor and recipient. * Because it is scheduled rather than performed when a kidney becomes available, recipients can begin taking immunosuppressive drugs several days before the transplant to pre-condition their immune systems to accept the transplant. The practice is believed to reduce the risk of organ rejection. * Kidneys from living donors are transplanted immediately after they are removed, so the organs spend less time outside the body and don't require cold preservation time, which can prevent a transplanted kidney from immediately functioning. "Transplanting a healthy kidney that works immediately is probably more important than having a good genetic match," Lowell points out.

Spouses and friends who donate a kidney face the perils of major surgery, including a very small risk of pneumonia or blood clots following the operation. The most troublesome aftereffects are the pain of the surgical incision, followed by weeks of recuperation. The donor's risk of losing the remaining kidney is considered very small.