Despite the 93,000 patients in the US seeking a kidney transplant, a new report reveals that some 3,500 donated kidneys go unused and even thrown away every year.
A study published in JAMA Internal Medicine this week found that 17% of donated kidneys in the US were discarded during a 10-year period. By comparison, in France, only about 9% of donated kidneys went unused during the study period.
Why the waste? According to the report, doctors here in the US are less inclined to risk using lower-quality kidneys, even though previous studies have shown that even less desirable kidneys, such as older kidneys and those with abnormalities, are still better than dialysis.
In France, doctors are more willing to use kidneys from deceased patients who suffered from illnesses such as diabetes or hypertension.
Cost may also be a factor in US doctors’ reticence to use affected kidneys, since these transplants may also result in extended hospital stays.
And, without a consistent set of guidelines in the US, some regions discard more kidneys than others based on their own opinions about whether a kidney is viable, according to a 2016 study by the National Kidney Foundation. That study found that as many as 50% of discarded kidneys could have been transplanted.
The United Network for Organ Sharing (UNOS) — the US’ transplant governing body — attempted to improve the discard rate by creating a kidney donor profile index in 2012, which rates how long it predicts a kidney will hold up. The network even lowered its standards in 2014 so that lesser kidneys would be considered.
The problem is wide-reaching: More than 37 million Americans suffer from chronic kidney disease, with roughly 5,000 of these patients dying each year on the transplant waiting list.
Still, the number of wasted kidneys continues to rise, up to 30% in some regions, according to a study published in January 2019.
In the end, “risk-averse” policies in US transplant programs hit patients hardest, write Dr. Ryoichi Maenosono and Dr. Stefan G. Tullius of Brigham and Women’s Hospital, in a commentary article attached to the JAMA study.
“Hospital administrators and patients alike are attracted by superficial five-star ranking approaches that are easy to read but not necessarily reflective of the approach of individual programs aiming to provide their patients on waiting lists with the best opportunities.”