Health Day reporter
THURSDAY June 24, 2021 (HealthDay News) – In the chronicle world kidney disease, the dilemma is not uncommon: a relatively young patient with kidney problems may require a transplant later, and an older family member is more than ready to step in. But the need for a kidney transplant, while predictable, is not immediate.
Thus, the older donor does not act. Since the supply of donors has never met the demand, the loss of a golden opportunity – due to age or circumstances – has long frustrated members of the kidney transplant community.
But a new study reports on what appears to be a possible solution to the problem: kidney-friendly ones.
“It’s like a coupon to be used in the future,” said study author Dr. Jeffrey Veale. He is a kidney transplant specialist in the Kidney Transplant Exchange Program at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA). “And that makes a lot of sense. Especially for older people who want to be living donors – grandparents, for example – but who would need to donate now, even if the family member to whom their kidney is meant to not need it right now. “
Veale explained that when donors enroll in the voucher program, they are in fact donating their kidneys to a stranger in immediate need. But in doing so, they then receive a voucher that they can then assign to the person or people they really want to help.
In turn, that patient can then ‘redeem’ their voucher at any time in the future, immediately obtaining ‘priority status’ on the donor waiting list for another living donor whenever their the need becomes immediate.
Veale said it was UCLA patient Judge Howard Broadman who first proposed the idea seven years ago. Under Veale’s care at the time, Broadman had decided to donate one of his kidneys to a stranger, with the understanding that by doing so he could then “bank” a kidney for his grandson, if needed.
Kidney vouchers encouraged ‘living donation’
Since then, the voucher program has expanded to 79 locations across the United States, where the process is highly regulated and controlled.
Kidney vouchers are issued at the time of donation and are not transferable. Each donor can assign a voucher to up to five different potential recipients, including those without kidney disease. But in the end, only one of them, the first in need, will be able to use it.
Vouchers also do not offer any guarantee that a kidney will actually be available right away. They also do not move the holder up the queue for a kidney acquired from a deceased person; priority is only given to kidneys donated by other living donors. And if the holder dies or becomes, for whatever reason, ineligible for a transplant, the voucher becomes null and void.
So, have kidney vouchers triggered an increase in live kidney donation?
After reviewing data compiled by the National Kidney Registry, Veale said the answer is yes.
Registry figures show that between 2014 and 2021, a total of 250 donations were made under the voucher program at 79 transplant centers.
The donors were between 19 and 78 years old. Among them, almost 8% were over 65 years old. Almost two-thirds were female and almost all (96%) were Caucasian, according to the results.
Better results when the kidney is from a living donor
During the study period, six beneficiaries used the voucher. Meanwhile, the transplant waiting period for people on the registry has been reduced by three months, according to the report published online June 23 in JAMA surgery.
Veale’s team concluded that the voucher program does what it’s designed to do: convince hesitant donors to go ahead, knowing their loved ones are covered.
“The idea was initially rejected in the transplant community because it really went off the beaten track,” Veale said. “But it’s getting huge. Hundreds of coupons have been made. And it’s definitely making a difference. There’s no question that the program is able to get donors who otherwise wouldn’t donate.”
Since “the need to save lives [living] kidney transplants are significantly outstripping supply, ”said Dianne LaPointe Rudow. She is the Director of the Living Donor Program in the Department of Population Health Sciences and Policy at the Recanati Miller Transplantation Institute at Mount Sinai Hospital, New York.
Rudow noted that although about 98,000 patients are on the kidney transplant waiting list, only about 39,000 transplants are done each year. Of these, only 5,000 to 6,000 come from living donors.
“Kidneys from living donors generally perform better and last longer,” she said. “Plus, you can schedule the transplant before a patient has spent years on dialysis.”
But while being “cautiously optimistic” about the voucher program’s ability to improve the numbers, Rudow said it was important for potential donors to know the details. For example, she pointed out that as a private, non-profit organization, the Kidney Registry “has no federal oversight and there is no guarantee that it will exist when a person is ready for a kidney.”
Still, “the concept of a voucher can help people feel comfortable being a living donor to a stranger, especially if they know there is protection for their family,” Rudow added.
There is more on live kidney donation at National Kidney Foundation.
SOURCES: Jeffrey Veale, MD, urologist and kidney transplant specialist, Kidney Transplant Exchange Program, UCLA Health, Department of Urology, David Geffen School of Medicine, University of California, Los Angeles; Dianne LaPointe Rudow, PhD, Director, Living Donor Program, Department of Population Health Science and Policy, Recanati Miller Transplantation Institute, Mount Sinai Hospital, New York; JAMA surgery, June 23, 2021, online