Life or Death

A recent New York Times report documented a shockingly inefficient system that decides who lives or dies waiting for a kidney transplant. While no one questions a need to avoid the cost of marginally successful surgery, the facts seem to call for a total reevaluation of the system when nearly 4,800 people died last year waiting for a kidney and over 2600 donated kidneys were discarded.

One disturbing report detailed the tragic death of a healthy 36-year-old. His liver and one kidney were transplanted into waiting patients. His other kidney -just as healthy- was ultimately offered to more than 10,000 potential matches with no takers. It ended up discarded - disgraceful.

The systems for allocating livers, hearts and lungs have been revised to take into account the urgency of need and the life expectancy of the recipient, factors that are disregarded in the case of kidneys. Efforts to update these and other outdated rules take years to change. Meanwhile, perfectly good kidneys are being tossed in the garbage and people are dying. How dumb is that?

One might question the ethics of the medical centers that turn down marginally viable kidneys for patients in need. But it’s not that simple. One kidney center was censured because they had an 88% success record. In order to keep from being decertified they cut back the number of kidney transplants done and raised their success rate to 96%. The doctor in charge of the program mused which would you choose 88 successful transplants out of 100, or 59 out of 60? The choice of the 29 people who might have been saved is crystal clear. 

According to the Times story, “A computer simulation suggests that a redesigned system could add 10,000 years of life from one year of transplants.” Currently an outdated computer matching program makes the process inefficient. Add to that government oversight, the overreliance by doctors on inconclusive tests and even federal laws against age discrimination. Medical rationing that arguably gives all candidates a fair shot at a transplant but does not save as many lives as it might. 

We can all agree that dumping organs that might give life to those in need is not what we should be doing. We should all agree that the reported 14,484 kidneys recovered last year is pitiful; especially in light of the 93,413 folks waiting for one recently (2012.09.19). It’s disgraceful that all last year something less than 7,500 people remembered to make sure that should something fatal befall them, their organs could help others live. Who could possibly not want that to happen? 

There is no easy way to estimate the potential number of organs that could be recovered. But consider that the latest available annual highway death toll in 2010 totaled 32,885 individuals, a number that could vastly increase the number of organs recovered. Then add in other accidental deaths, and deaths from a wide variety of causes and it becomes apparent that we are ignoring an opportunity to give the gift of life, perhaps to several people. Shame on us!