U.S. doctors are discarding donated kidneys that could keep people alive for years, simply because the organs are not top-quality, a new study claims.
“Suboptimal” kidneys from older donors with health problems perform much better than expected, and would preserve a patient’s life much longer than dialysis, said lead researcher Dr. Sumit Mohan. He is an associate professor of medicine & epidemiology at Columbia University’s Mailman School of Public Health.
About 73 percent of lower-quality kidneys received by Columbia patients were still functioning five years after transplant, Mohan and his colleagues found.
“To our surprise, yes, they did worse than the best-quality kidneys, but they didn’t do that poorly,” Mohan said.
By comparison, the five-year survival rate for kidney patients on dialysis is about 35 percent, Mohan said.
“If I don’t get a kidney, my alternative is to stay on dialysis,” Mohan said. “Even getting a suboptimal kidney provides a huge survival advantage.”
Unfortunately, about 1 in 5 donated kidneys winds up in a trash can in the United States, Mohan said, even though the United Network for Organ Sharing shows more than 97,000 people are now on the waiting list for a kidney transplant.
These kidneys are discarded because biopsies of donated organs reveal scarring or other problems that make them less than ideal, Mohan said.
When is a donor kidney good enough?
Some low-quality kidneys are rightfully discarded, Mohan said, but he suspected that many donor kidneys could still provide years of good function.
To test this idea, Mohan and his team reviewed 975 kidney transplants that occurred at Columbia University Medical Center between 2005 and 2009.
Kidneys from living donors provided the best outcome for patients, with 91 percent still working five years after transplant regardless of whether the organ was damaged, the researchers found.
Living donors undergo intense screening to make sure they are healthy enough to donate a kidney, Mohan explained. In addition, kidneys from living donors are not damaged during organ preservation and transport.
“You should take a living donor kidney regardless of anything else you know about that living donor,” Mohan said. “It’s always going to be better than a deceased donor kidney.”
But high-quality kidneys from deceased donors functioned well, with nearly 82 percent still working after five years, the researchers found.
Surprisingly, most lower-quality kidneys also remained viable for nearly as long as the best kidneys, with 73 percent still working five years after transplant, the study showed.
By eight years after transplant, 62 percent of optimal kidneys and 53 percent of suboptimal kidneys from deceased donors still functioned, Mohan said.
The findings were published online July 6 in the Journal of the American Society of Nephrology.