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Kidney and bladder health

29 August 2019

Thousands of kidneys thrown away by US transplant centers

New research has found that in France kidneys from older donors are much more likely to be used for transplants than in the United States.

When it comes to using kidneys from deceased donors, the United States might want to follow France's example.

That's according to new research that found kidneys from older donors are much more likely to be used for transplants in France, and if more of those "lower-rated" kidneys were used in the United States, tens of thousands more Americans would receive a kidney transplant.

Disparities in organ acceptance

Between 2004 and 2014, US transplant centres discarded about 18% of over 156 000 deceased-donor kidneys recovered, about two times higher than the discard rate in France.

Meanwhile, French transplant centres would have transplanted more than 60% of the nearly 28 000 kidneys refused in the United States during that time, the findings showed.

"These findings highlight the striking disparities in organ acceptance between the two countries and suggest that many of the 90 000 Americans awaiting a kidney transplant could reap major benefits from a more aggressive approach," said study co-author Dr Peter Reese. He's an associate professor of medicine and epidemiology at the University of Pennsylvania, in Philadelphia.

Age seemed to be a deciding factor with deceased donors.

The average age of a kidney donor in France was 56 years old, compared with 39 in the United States, according to the study published in JAMA Internal Medicine.

Age a risk factor

"Our study provides fresh evidence that organs from older deceased donors are a valuable, underused resource – particularly for people on the waitlist who otherwise may not receive a transplant at all," Reese said in a university news release.

About 37 million U S adults have chronic kidney disease, and more than 720 000 have kidney failure and require either a transplant or dialysis to survive. Every year, 5 000 people in the United States die while waiting for a kidney transplant.

Organ donor age is a risk factor for transplant failure, but research shows that kidneys from donors in their 50s or 60s may extend the lives of transplant candidates, particularly older recipients, according to the report.

The study authors also noted that it's been found that transplant candidates older than 65 lived longer if they shortened their transplant wait time by accepting kidneys from "extended criteria" donors – those older than 60, or those older than 50 with health problems, such as high blood pressure.

There is a large need for kidneys for older adults in the United States, where the proportion of transplant recipients older than 60 rose from 22% in 2004 to 32% in 2017, the study authors said.

Thousands die each year

In the United States, there are more than 35 000 people older than 60 waiting for a kidney. By following France's example, the United States could provide more than 10 000 years of life with a functioning kidney transplant to patients each year, the researchers said.

According to study co-author Dr Alexandre Loupy, "This study demonstrates that there is more the US can do to prevent the deaths of thousands of Americans each year who are waiting for a transplant." Loupy is a nephrologist in the department of nephrology and kidney transplantation at Necker Hospital in Paris and head of the Paris Transplant Group.

"Our findings reinforce how collaboration between countries can lead to a concrete, new direction on how to help address a global health problem and advance care for wait-listed kidney patients in the United States," Loupy added.

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