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Kidney transplants: The United States discards 3,500 donated kidneys each year



The lack of organs for patients with kidney failure is a major public health problem, and one that President Donald Trump addressed in July when he signed an executive order promising to transform kidney care in that country.
More than 37 million Americans have chronic kidney disease and approximately 5,000 die each year while on the waiting list for kidneys. That's about 12 people every day, making kidney disease the ninth leading cause of death in the United States.

In this new study, researchers looked at the number of deceased organ donors offered at kidney transplant centers between 2004 and 2014 during this period, 156,089 kidneys were donated; 128,102 were transplanted; 27,987 were discarded. This means that over 1

7% of the kidneys donated in this United States have been discarded.

Since the end of the 2014 study period, the number of discarded kidneys has increased. In 2016, 3631 donated kidneys – about 20% – were discarded, according to researchers.

In comparison, in France only about 9% of donated kidneys were discarded during the study period. The difference was because in France doctors were more likely to use older kidneys and kidneys than people suffering from other conditions such as diabetes or hypertension.

Research finds that new approaches to treating complications from donated organs make transplantation Even lower organ quality, better than dialysis, but US policies have not kept pace.

One of the main drivers of this trend, according to the authors, is that there is "intense regulatory oversight of US transplant programs. They may lose their credentials if the results of their one-year death and graft failure exceed the predicted results." In other words, if the organ is not in the best shape, the transplant centers may be at risk of unwillingness to take the risk.

There are guidelines, but there is no one universally applied method to determine which kidneys will be transplanted and which kidneys will be discarded.

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[19659003] There are several other reasons for a kidney to be discarded. It may be in poor shape, there may be an abnormal organ biopsy or some other physical issues. But there are also financial and regulatory reasons why they are thrown away. The older kidney or the one with concomitant diseases costs more to transplant, as the patient is hospitalized longer and needs longer recovery time.

Some regions discard more kidneys than others, the study said, suggesting that the decision to retain or discard a donor organ is at least somewhat subjective.

A 2016 study of discarded kidneys deemed unfit for transplantation was reviewed by a panel of transplant experts who found that 50% of the kidneys that were discarded could be transplanted, according to the National Foundation for Transplantation. the kidneys.
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To address this problem, the United Nations Organ Sharing Network (UNOS) – which manages the transplant system in the United States – has created a kidney donor profile index, which has been used since 2012. The result predicts the survival of deceased kidney donors. In 2014, UNOS changed the kidney distribution system to make higher quality kidneys available to a wider region, but none of these initiatives changed the speed of discarded organs. The number of discarded organs has actually increased to 20%, according to a study published in January 2019. It is 14.9% in 2006, and in some regions the discard rate is even higher than 30%.
For years, kidney advocacy organizations have called for a change in the standards used to determine whether a donated kidney should be transplanted or discarded.

An invitation to comment, accompanied by a study on Tuesday, mentions that Europe uses an "old-for-old" approach, which means an older kidney that might otherwise be rejected may be suitable for an older patient. Usually biopsies, which are done in the US, may not be the best predictor of organ quality. Biopsies are less common in Europe. The comment also suggested that regulations would have to change.

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"It is acknowledged that the overly rigorous and restrictive monitoring process of transplant programs in the United States has led to many programs for transplants adopting a risk-based approach, "Dr. Rioichi Maenosono and Dr. Stefan G. Tulii of Brigham and Women's Hospital wrote in the comment. "Hospital and patient administrators are drawn to superficial five-star rating approaches that are easy to read but do not necessarily reflect the approach of individual programs designed to provide their patients with best-waiting lists."
Centers for Medicare and Medicaid Services (CMS) are considering eliminating some regulations that put these transplant programs at risk if the programs do not meet the expected results.
Kidney disease is an expensive problem for the United States. Currently, the government spends over $ 114 billion annually on patients with kidney disease. According to HHS Secretary Alex Azar, that's one fifth of all Medicare dollars spent.

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