"Performing renal transplant with a perfectly healthy kidney to all the patients with ESRD is
an ideal scenario. But growing waiting lists and shortage of kidneys makes it necessary to
make some compromises. Use of so-called, marginal or borderline donors can increase
donor pool by almost 20 to 25%." (Renal Transplantation from
Expanded Criteria Donors. Renal Transplantation – Updates and Advances. Pooja Binnani, et al). See here to see the full article on the subject from which this quote was taken.
To put it in plain english, if a person cannot a brand new BMW does that mean he doesn't buy a car at all or does he buy a used Toyota Camry? Obviously, the person takes what they can afford to drive. A person would much prefer an Expanded Criteria Donor (ECD) kidney and significantly increase his probability of 5 year survival than insist on a Standard Criteria Donor (SCD) kidney and being dead by the time it would be his turn on the waiting list.
According to information on UC Davis Transplant Center website found here, "[s]tudies have shown that transplant patients who receive either SCD or ECD kidneys have a superior survival when compared to remaining on dialysis." It also states that, "[a]ccepting an ECD kidney may significantly decrease the amount of time a person waits for transplant. The ECD kidney comes with some risk for earlier graft loss but the exact risk is unknown. A good estimate is that 8 of 10 ECD kidneys will still be functioning at one year while 9 of 10 SCD kidneys will be functioning at one year. At 5 years, half of ECD kidneys will still be functioning compared to 7 of 10 SCD kidneys."
Below is the survival percentage for people with ESRD depending on their mode of treatement at the 5 year point of time. Kidney transplantation offers highly superior survival rate - 33%-39% increase in 5 year survival - compared to the other treatment modalities (See Below). Even if the use of Expanded Criteria Donor Kidneys shaved a few percentage points off the 5 year survival, most people will still benefit from receiving these organs that are currently frequently discarded.
Again, while in an ideal world everyone would receive the highest quality kidney possible, people's probability of 5 year survival is greatly increased even if they receive an ECD kidney.
| 2004 ESRD cohort: 5 year survival based on treatment modality | ||
| Dialysis | 34% | |
| Hemodialysis | 34% | |
| Peritoneal dialysis | 40% | |
| Transplant | 73% | |
| based on http://www.usrds.org/2011/view/v2_05.asp | ||
so the question is: what sorts of health problems was the donor of the "expanded" kidney list having that the standard donor was not?
ReplyDeleteon the other hand,the survival rates comparisons seem closer than one might otherwise expect, so just how inferior are the expanded list kidneys? are they at all?
Alan Busch
According to the UC Davis Medical Center linked to above, the health problems related to the expanded criteria kindey are the following: "The expanded criteria donor (ECD) is any donor over the age of 60, or a donor over the age of 50 with two of the following: a history of high blood pressure, a creatinine (blood test that shows kidney function) greater than or equal to 1.5, or death resulting from a stroke."
ReplyDeleteThe life expectancy of the transplanted organ (not of the people who can remain alive by returning to dialysis) as measured by the 5 year survival rate of the kidney is 70% for "optimal kidney transplants" compared to 50% for "suboptimal kidney transplants." Obviously, there is a significant difference. However, compared to either form of dialysis, life expectancy rates of the people are significantly increased by either type of transplant.