Friday, February 25, 2011

New Kidney Transplant Policy to Favor Younger Patients

Out of all the marvelous and amazing articles in the New York Times on February 25, 2011, the one I want to single out, which I think has enormous implications for many individuals and families, concerns a new policy being proposed by the kidney organ transplant network to give younger patients preference over older patients when it comes to kidney transplants. The principle at stake is to let younger and healthier patients have access to kidneys that they can use over a much long period of time due to their greater life expectancy. As Richard N. Formica put it, a transplant physician at Yale University and one of the authors of the new policy, "Right now, if you're 77 years old and you're offered an 18-year-old's kidney, you get it. The problem is that you'll die with that kidney still functioning, while a 30-year-old could have gotten that kidney and lived with it to see his kids graduate from college."

As Gardiner Harris explains in his New York Times piece, a pool of young and otherwise healthy patients would have access to the best kidneys. Amounting to about 20% of organ recipients, these are the patients with the longest life expectancies and the ones with the greatest chance to live with their donated kidneys for as long as 30, 40 or even 50 years. The remaining 80% awaiting transplants would receive transplants when the difference in age between recipient and donor is not more than 15 years. Thus, a recipient at age 80 would be given preference if a donor were 65 or older. A recipient at age 60 would be given preference if a donor were 45 or older and so on.

Although there is a great deal of support for this policy within the medical community, there are some who oppose it vociferously, because the problem of geographical disparity is not addressed by this proposal. Dr. Lainie Friedman Ross, the Associate Director of the McLean Center for Clinical Medical Ethics at the University of Chicago, says that geography is the biggest challenge and that this proposal does nothing to deal with the difference between living in Florida where kidneys are more available and in New York or Chicago where there are significant scarcities.

Dr. Formica believes that most people will be unaffected by the new policy, but Dr. Ross asserts that most people over 65 will lose access to kidneys, if this policy goes into effect, which is another reason why she opposes it.

Arthur Caplan, an ethicist at the University of Pennsylvania's Center for Bioethics and a supporter of the policy, think it's fairly simple. "If it's a choice between saving grandpa or granddaughter, I think you save granddaughter first. It doesn't make sense to give people equal access to something if some people fail to benefit," or, to put it another way, it doesn't make sense when some people can derive a benefit for 50 years, while others have only 10 years or less to take advantage of what has been donated to them.

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