[Diabetes-talk] FW: UF Health News: OLDER KIDNEY TRANSPLANT PATIENTS SHOULD MORE OFTEN CONSIDER LIVE DONORS

[Ed Bryant]

Hi folks, 

The following may be of interest to you. 

 

Regards,

Ed Bryant

 

 

From: Powers,Elizabeth T [mailto:bpowers at ufl.edu] 
Sent: Friday, June 12, 2009 1:16 PM
To: Smith,Kimberley D
Subject: UF Health News: OLDER KIDNEY TRANSPLANT PATIENTS SHOULD MORE OFTEN
CONSIDER LIVE DONORS

 

Below is the latest news provided exclusively by request for subscribers of
UF Health Newsnet, which provides news reports and story tips about the
latest medical and health advances from the University of Florida Health
Science Center. 

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OLDER KIDNEY TRANSPLANT PATIENTS SHOULD MORE OFTEN CONSIDER LIVE DONORS

 

EMBARGOED UNTIL 12:01 A.M. EDT JUNE 18

 

ATTENTION EDITOR: Photo available at
www.news.health.ufl.edu/media/recentNews.aspx.

 

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GAINESVILLE, Fla. - Almost half of kidney transplant candidates older than
60 who are put on the waiting list for a deceased-donor organ will die
before getting a transplant, according to new findings from the University
of Florida, Cleveland Clinic and Case Western Reserve University.

 

Wait times to receive a deceased donor kidney transplant have increased over
the years, but this study is the first to define and quantify what this wait
time means for older patients. Researchers suggest that some candidates
should consider live-donor options rather than wait for deceased-donor
organs to become available.

 

The findings give firm data that can guide patients in making decisions, and
policymakers in allocating donated organs.

 

"If someone knows that they have a 10 percent chance of dying before
transplantation, they might consider it differently than if they know they
have an 80 or 90 percent chance," said Jesse Schold, Ph.D., an assistant
professor of medicine and first author of the paper published today (June
18) in the Clinical Journal of the American Society of Nephrology.
"Understanding what these survival estimates are may provide a more
objective and useful basis for evaluating donor options for this
population."

 

The researchers suggest that some patients need to ask their doctors about
their chances of surviving to receive a transplant, and, once they decide,
to speed through the steps necessary to get on the waiting list. It can take
several months for patients to go from primary care provider referral to a
transplant center and through the  medical tests and additional steps
involved in getting their name on the list.

 

"Older patients must be referred for transplantation sooner than they are
now, and they need to be guided through the process of pursuing live donor
kidney transplantation," said Harvard transplant psychologist Jim Rodrigue,
Ph.D., director of behavioral health services and research in the Transplant
Institute at Beth Israel Deaconess Medical Center. "The older population is
least likely to pursue a live donor transplant and is less likely to have
healthy living donors available."

 

That's because the older people get, the older their siblings and peer
network become, with potentially more medical problems than when they were
younger.  And older patients tend to say they do not want to burden their
adult children, other relatives or friends by asking them to be live donors.

 

About 50 percent of the more than half a million people in the United States
who have end-stage renal disease are older than 60. In medically eligible
patients, kidney transplantation gives a better survival chance than
dialysis.

 

The UF team examined data from the national Scientific Registry of
Transplant Recipients for almost 55,000 candidates older than 60 who were
listed for a single-kidney deceased-donor transplant from 1995 through 2007.
They used statistical models to estimate the time to receive a transplant
and time to death after getting on the list.

 

Although overall about half of the over-60 group was projected to die before
transplant, different subgroups had even higher likelihood of dying before a
transplant.. 

 

Long-standing racial disparities are borne out by the data, with black
patients having a higher probability than white patients of dying before a
transplant: Sixty-two percent of black patients older than 60 will likely
die before getting a transplant.

 

"That is an important finding because African-Americans are substantially
less likely than whites to receive a live donor transplant, regardless of
age," Rodrigue said. "For those who are over 60, this is simply more bad
news." 

 

Another notable disparity is that people's survival chances vary greatly -
from 8 percent to 81 percent - depending on where in the country they happen
to live.

 

"It seems inherently unjust that we have such significant geographic
disparity in survival on the waiting list based on where you live," Rodrigue
said. 

 

It is true that some regions are better than others at recovering organs and
have better donor rates. But based on the study's results, one thing for
policymakers to consider might be redrawing geographical boundaries of
designated transplant regions so that more people have a better shot at
getting an organ. 

 

"We like to promote equity and policies that give a fair chance," Schold
said.

 

[EDITORS: STORY MAY END HERE]

 

While the study findings support broad conclusions about patients' survival
chances, they might not apply to individual patients.

 

Still, Rodrigue said, they will change the doctor-patient conversations at
his institute, for one. In the past, the underlying assumption was that
patients will eventually get a deceased donor organ.

 

"Now we'll have a more directed conversation with patients about the risk of
death," he said. "It's not just how long you wait."

 

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