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Kidney Transplants: The US discards 3,500 donated kidneys each year



The lack of organs for patients with kidney failure is a serious public health problem that President Donald Trump raised in July when he signed a decree promising to change kidney care in that country.
More than 37 million Americans have done this On the waiting list of the kidneys are chronic kidney disease and about 5,000 deaths per year. That's about 12 people a day, making kidney disease the ninth-leading cause of death in the United States.

In this new study, researchers investigated the number of deceased donors with organs offered to renal 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 more than 1

7% of kidneys donated in the US were thrown away.

Since the end of the study period in 2014, the number of discarded kidneys has increased. According to the researchers, in 2016, 3,631 donated kidneys – about 20% – were discarded.

By comparison, in France only about 9% of the donated kidneys were discarded during the study period. The difference was that doctors in France were more willing to use older kidneys and kidneys from people with other conditions, such as diabetes or high blood pressure.

Research has shown that new treatment approaches to treat the complications of donated organs make transplantation possible Even a lower quality organ is a better option than dialysis, but US policy has not kept pace.

One of the main drivers of this trend, according to the authors, is that the US transplant programs are under intense regulatory control, which may lose their credentials if their one-year death and graft failure results exceed the projected results. "In other words, if the organ is not in the best shape, transplant centers can be risky to take a risk.

There are guidelines, but not a commonly used method to determine which kidneys are transplanted and which kidneys are thrown away

  Stevie Wonder announces that he will undergo kidney surgery in September

19659003] There are several other reasons why a kidney is thrown away It may be in poor condition, there may be an abnormal biopsy on the organ or other physical problems, but there are also financial and regulatory reasons that may discourage it – an older kidney or a kidney with comorbidities costs more for transplantation, because a patient stays longer in the hospital and the recovery takes longer.

Some regions n throw more kidneys than others a donated organ is at least somewhat subjective.

A 2016 study of discarded kidney non-transplantable was reviewed by a panel of transplant experts who could have transplanted up to 50% of discarded kidneys The National Kidney Foundation.
  A Minnesota woman donated her kidney to a firefighter who hurried after a seizure to help her daughter.
To address this issue, the United Nations Network for Organ Sharing (UNOS), which governs the US transplant system, has created a kidney donor profile index that has been in use since 2012. The score predicts the survival of deceased donor kidneys. In 2014, UNOS changed the kidney allocation system to allow lower quality kidneys to be offered to a wider region. However, none of these initiatives has changed the rate of discarded organs. According to a study published in January 2019, the number of discarded organs has risen to 20%. It was 14.9% in 2006 and even more than 30% in some regions.
For years proponents of kidney organizations have called for a change in standards that will be used to determine whether a donated kidney should be transplanted or discarded.

In an invited comment accompanying the study from Tuesday, it was mentioned that Europe uses an "old-for-old" approach, meaning that an older kidney that could otherwise be rejected might fit well for an elderly patient. Biopsies, commonly performed in the US, may not be the best predictor of organ quality. Biopsies are less common in Europe. The comment also indicates that regulations need to change.

  He wanted to help a neighbor. He became the oldest living kidney donor.

Risk-averse approach, "wrote Dr. Ryoichi Maenosono and Dr. Stefan G. Tullius of Brigham and Women's Hospital in the commentary "Hospital administrators and patients alike are fond of superficial five-star approaches that are easy to read but do not necessarily reflect the approach of individual programs designed to offer their patients the best chance on waiting lists."
The Centers for Medicare and Medicaid Services (CMS) are considering removing some prescriptions that jeopardize the resources of these transplant programs if the programs do not meet the expected results.
Kidney disease is a costly problem for the US The government is currently spending more each year $ 114 billion for kidney disease patients, according to HHS secretary Alex Azar as a fifth of the spending of all Medicare dollars.

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