Report: Younger Transplant Patients Would Get the Best Kidneys

[Greenbeard]

age discrimination was never a factor in making the best match. If this law passes it will be. Just be honest about it.

What law? Do you have any idea what's going on here?

Let me try and help you out. First of all, understand the basics: almost thirty years ago, the federal government authorized the creation of an Organ Procurement and Transplantation Network (OPTN), to be operated by a private non-profit under contract with the feds. The OPTN's function, put simply, is to allocate organs. Longstanding federal rules require the OPTN's Board of Directors to develop a policy for doing this that, among other things, "Shall be designed to avoid wasting organs, to avoid futile transplants, to promote patient access to transplantation, and to promote the efficient management of organ placement" and "Shall be reviewed periodically and revised as appropriate." You may think this is a death panel but it certainly isn't new; it was established under Reagan almost three decades ago.

Second, understand the concept here. The particular policy under discussion here is about the allocation of kidneys and kidneys alone. Transplants of other organs already take into account relevant factors besides the time a name has been on a list. Kidneys, on the other hand, are handed out rather blindly:

Organ allocation is the process the OPTN uses to determine which transplant candidates are offered which organs. Each organ allocation system attempts to achieve different goals. For example, livers are allocated based on a candidate’s chance of dying while waiting for a transplant. Those candidates at highest risk are transplanted ahead of candidates at lower risk. Lungs are allocated based on the candidate’s chance of dying while waiting for a transplant and also on the chance of dying during the first year following transplant. In this way, the liver and lung allocation systems both attempt to minimize death on the waiting list. The lung allocation system is designed also to maximize survival in the first year after transplant. Kidneys are currently allocated based primarily on how long a candidate has been waiting. This is not how the Kidney allocation system was initially designed. Initially, allocation priority was heavily weighted based on closely a candidate ‘matched’ a kidney by tissue type testing. In the past, closer matching was necessary for acceptable results. With improvement in anti-rejection medications, the priority for tissue typing has been decreased greatly over the last several decades. While the current design of giving most of the priority based on waiting time may be perceived as “fair”, it does not strive to minimize death on the waiting list nor promote maximize survival following transplant. It does not recognize that all candidates do not have the same ability to survive the wait. It does not attempt to match the characteristics of a donor’s kidney to the candidate’s characteristics to promote a long and healthy survival post-transplant. The system can be better and it can be designed to achieve more in the way of health and longevity than it currently does.

Third, understand the genesis of this current development. The OPTN's Board of Directors--those folks charged with devising the allocation policy that should "be reviewed periodically and revised as appropriate"--decided almost six years ago to review and revise their kidney allocation polices (which, as they noted in the quote above, they think aren't particularly good). So they asked their standing Kidney Transplantation Committee to address the issue.

How did this committee go about its work and what did it find?

In an effort to understand the current system’s limitations and opportunities for improvement, the Committee held a series of public hearings, two public forums, gave many presentations to stakeholders, and reviewed hundreds of submitted comments.

During the public hearings, the Committee heard from the transplant community that the limitations of the current system include the following:

• high discard rates of kidneys (especially those from expanded criteria donors [ECD]) that could benefit candidates on the waiting list,
• variability in access to transplantation by blood group and geographic location, and
• many kidneys with long potential longevity being allocated to candidates with significantly shorter potential longevity and vice versa. This results in unrealized graft years and unnecessarily high retransplant rates.

They laid out the goals for kidney transplantation that they came to with stakeholders via this open process (particularly from a public forum that the committee held in January of 2009) and have now come up with three proposals for improving the current kidney allocation policy:

1. Utilizing a kidney donor profile index (KDPI) to better characterize donor kidneys and to provide additional clinical information for patients and providers to consider during the transplant evaluation process and organ offer process. The KPDI is a continuous measure used to estimate the potential function of a donated kidney if it were transplanted in to the average recipient.
2. Allocating the majority of organs (80%) by age matching so that candidates within 15 years (older and younger) than the donor are prioritized. This is a 30 year time span around each deceased donor’s age.
3. Allocating some kidneys (20%) by the combination of the kidney donor profile index (KDPI) and candidate estimated post-transplant survival (EPTS).

You, as a member of the public, are invited to review their proposal and provide feedback before April 1: you can read it and submit public comments here.

To sum up:

1. No law has changed. The OPTN is reviewing its own policy, with stakeholder and public input.
2. Organs are not all allocated indiscriminately, which is why the policy under review here pertains to kidneys, which, for the most part, are.
3. The ACA ("Obamacare") has absolutely nothing to do with this.
4. This "death panel" (the OPTN) has been death paneling since the mid-80s.
5. This process of reviewing and potentially revising the kidney allocation policies began years ago.

 

[WillowTree]

I would not call it a death panel at all. It is about placing an organ at the time of harvest, where it has the best and longest survivability. Though both young and old can and do reject organs.

Placing an organ in a younger healthy body that has a longer life span as opposed to an older sicker body with a shorter life span is stupid.

Anyone on "the list" is going to die anyway, They got their on their own, no death panel required to put them there. The ones who receive the gift of a donated organ are given a second chance at life.

Organs are not like drugs and hip replacements where the parts are manufactured. They are not surgeries that are given or withheld because of cost efficiency.

Old people shouldn't give organs. Old organs are worn out. I got it.

I have never said that old people should not give or receive organs. I am saying that if there is more then one match for the organ it should be placed in the body that has the longest visibility for the organ. Notice that i do not say old or young. I say the one where the organ has the longest chance survivability.

And as to old people donating organs. A friends wife got a corneal replacement that failed in less then a year. It turns out that that donor was over 80.

Old people should donate all viable organs right along with younger people and increase the chances of anyone who needs organs and tissue.

No damn sense in placing an old organ in a young vital person. They should reserve old organs for old people since we're now into discrimination. That's cool.

 

[Greenbeard]

No damn sense in placing an old organ in a young vital person. They should reserve old organs for old people since we're now into discrimination. That's cool.

Proposal 2: "Allocating the majority of organs (80%) by age matching so that candidates within 15 years (older and younger) than the donor are prioritized. "

I had high hopes you'd read my above post. But I suppose I'm something of an optimist.

 

[RDD_1210]

No damn sense in placing an old organ in a young vital person. They should reserve old organs for old people since we're now into discrimination. That's cool.

Proposal 2: "Allocating the majority of organs (80%) by age matching so that candidates within 15 years (older and younger) than the donor are prioritized. "

I had high hopes you'd read my above post. But I suppose I'm something of an optimist.

The problem is you posted too many words. It has to be in very short, easily digested segments. Anything more then 14 syllables in a single post is just too much to handle.

 

[WillowTree]

No, I'm cool with it. We all have to die sometime. Let the old die and let them take their old organs with them, they're not worth saving. End of story.

 

[uscitizen]

No damn sense in placing an old organ in a young vital person. They should reserve old organs for old people since we're now into discrimination. That's cool.

Proposal 2: "Allocating the majority of organs (80%) by age matching so that candidates within 15 years (older and younger) than the donor are prioritized. "

I had high hopes you'd read my above post. But I suppose I'm something of an optimist.

willow already knows all.
She does not want to hear that Reagan actually created death panels

 

[WillowTree]

No damn sense in placing an old organ in a young vital person. They should reserve old organs for old people since we're now into discrimination. That's cool.

Proposal 2: "Allocating the majority of organs (80%) by age matching so that candidates within 15 years (older and younger) than the donor are prioritized. "

I had high hopes you'd read my above post. But I suppose I'm something of an optimist.

willow already knows all.
She does not want to hear that Reagan actually created death panels

That's it. You pegged me. That's why they're calling it "new rules" yep..



UNOS Considers Giving Organs to Younger, Healthier Patients - FoxNews.com

 

[WillowTree]

The possible changes are being welcomed by some bioethicists and transplant surgeons; however, others worry it would distort the pool of existing organs by modifying the model of people who make living donations. It could also discriminate against middle-aged or elderly patients.







Yep,, old WillowTree is full of shit and cannot comprehend "policy change" Nope.. that be the problem.

 

[WillowTree]

Yep,, that Old WillowTree be full of shit. How close to 50 are you??? huh??


The best kidneys are from young adults under age 35 years. Nobody over the age of 50 will ever see one of those," said Lainie Friedman Ross, a University of Chicago bioethicist and physician. "There are a lot of people in their 50s and 60s who, with a properly functioning kidney, could have 20 or more years of life. We're making it harder for them to get a kidney that will function for that length of time. It's age discrimination."

 

[geauxtohell]

BTW, weren't some of the shitheads on this thread the same shitheads that were applauding Arizona for taking people with HepC off the Medicaid Liver Transplant list?

If so, quit pimping medicine to advance your own partisan issues.

 

[geauxtohell]

What they did was good medical sense. Sometimes hard decisions have to be made. An organ should be placed where it will have the longest survival rate, not based on who was on the list longer.

Absolutely. I was on the list longer sounds like a union seniority thing.

Or one could look at it as a sound fiscal decision. Who will the govt get more return on investment from for the transplant a 20 yr old or a 70 yr old?

sorry folks but cutting spending has some effects that will not be popular.
for myself I would gladly give up the last year of my life so that a youngster would have a future. Family, children, etc.

But alas they do not want any of my organs, just shot to hell.

Organs should be placed where they have the longest survivability when there are several prime matches.

I know it is playing god, but the harvest of viable organs is to small to wast them.

Medicine is always going to be accused of "playing God".

That's the reality when you are involved in a life and death venture.

The only idiots are the people who think it's some sort of magical fantasy-land where the outcome is always optimal.

When you go to deliver your first child, you might have uncontrollable hemorrhage from your uterus and lose it to save your life.

Of course, since you actually were in the field, you know all this.

 

[syrenn]

Yep,, that Old WillowTree be full of shit. How close to 50 are you??? huh??


The best kidneys are from young adults under age 35 years. Nobody over the age of 50 will ever see one of those," said Lainie Friedman Ross, a University of Chicago bioethicist and physician. "There are a lot of people in their 50s and 60s who, with a properly functioning kidney, could have 20 or more years of life. We're making it harder for them to get a kidney that will function for that length of time. It's age discrimination."

That being said:

That is exactly why older people should be organ/tissue donors too. If a 60 year old dies it is more then likley that an older person will get the organs donated.

 

[geauxtohell]

With donor placement this is nothing new. It is not about death panels, but about the best match at the time of harvest.

age discrimination was never a factor in making the best match. If this law passes it will be. Just be honest about it. Now to decide knowingly that the old will be allowed to die is a Death Panel. All it calls for is naming it what it is. A death Panel. Sarah Palin should be President. She was the only one honest enough to call it.

I would not call it a death panel at all. It is about placing an organ at the time of harvest, where it has the best and longest survivability. Though both young and old can and do reject organs.

Placing an organ in a younger healthy body that has a longer life span as opposed to an older sicker body with a shorter life span is stupid.

Anyone on "the list" is going to die anyway, They got their on their own, no death panel required to put them there. The ones who receive the gift of a donated organ are given a second chance at life.

Organs are not like drugs and hip replacements where the parts are manufactured. They are not surgeries that are given or withheld because of cost efficiency.

Notice how they selectively ignore my article about the "God Panals" from the 60's ("God Panal" sounds so much nicer I suppose).

This isn't about medicine. It's about politics.

I would venture to guess that Willow couldn't tell you the difference in the proximal tubule and the collecting duct.

 

[syrenn]

age discrimination was never a factor in making the best match. If this law passes it will be. Just be honest about it. Now to decide knowingly that the old will be allowed to die is a Death Panel. All it calls for is naming it what it is. A death Panel. Sarah Palin should be President. She was the only one honest enough to call it.

I would not call it a death panel at all. It is about placing an organ at the time of harvest, where it has the best and longest survivability. Though both young and old can and do reject organs.

Placing an organ in a younger healthy body that has a longer life span as opposed to an older sicker body with a shorter life span is stupid.

Anyone on "the list" is going to die anyway, They got their on their own, no death panel required to put them there. The ones who receive the gift of a donated organ are given a second chance at life.

Organs are not like drugs and hip replacements where the parts are manufactured. They are not surgeries that are given or withheld because of cost efficiency.

Notice how they selectively ignore my article about the "God Panals" from the 60's ("God Panal" sounds so much nicer I suppose).

This isn't about medicine. It's about politics.

I would venture to guess that Willow couldn't tell you the difference in the proximal tubule and the collecting duct.

At times, medicine is about playing "god" and making decisions. No one is EVER always going to be 100% happy with the decisions made.

 

[WillowTree]

BTW, weren't some of the shitheads on this thread the same shitheads that were applauding Arizona for taking people with HepC off the Medicaid Liver Transplant list?

If so, quit pimping medicine to advance your own partisan issues.

Why don't you show us that applause of which you speak. Pimp.

 

[WillowTree]

I would not call it a death panel at all. It is about placing an organ at the time of harvest, where it has the best and longest survivability. Though both young and old can and do reject organs.

Placing an organ in a younger healthy body that has a longer life span as opposed to an older sicker body with a shorter life span is stupid.

Anyone on "the list" is going to die anyway, They got their on their own, no death panel required to put them there. The ones who receive the gift of a donated organ are given a second chance at life.

Organs are not like drugs and hip replacements where the parts are manufactured. They are not surgeries that are given or withheld because of cost efficiency.

Notice how they selectively ignore my article about the "God Panals" from the 60's ("God Panal" sounds so much nicer I suppose).

This isn't about medicine. It's about politics.

I would venture to guess that Willow couldn't tell you the difference in the proximal tubule and the collecting duct.

At times, medicine is about playing "god" and making decisions. No one is EVER always going to be 100% happy with the decisions made.

And, as long as the government practices discrimination neither I nor any of my family members will participate in that discrimination.

 

[uscitizen]

Notice how they selectively ignore my article about the "God Panals" from the 60's ("God Panal" sounds so much nicer I suppose).

This isn't about medicine. It's about politics.

I would venture to guess that Willow couldn't tell you the difference in the proximal tubule and the collecting duct.

At times, medicine is about playing "god" and making decisions. No one is EVER always going to be 100% happy with the decisions made.

And, as long as the government practices discrimination neither I nor any of my family members will participate in that discrimination.

so you nor your children will neither be organ donors nor recipients?

 

[Dot Com]

That's okay folks, I'm cool with it. Just so ya know though that there are death panels and Sarah Palin was correct. You owe her an apology.

That's why he stole that 960 Billion dollars he knew we wouldn't be needing it.

The possible changes are being welcomed by some bioethicists and transplant surgeons; however, others worry it would distort the pool of existing organs by modifying the model of people who make living donations. It could also discriminate against middle-aged or elderly patients.

Yep,, old WillowTree is full of shit and cannot comprehend "policy change" Nope.. that be the problem.

Possible means they wern't initially in the law so Sara Payland was wrong Willow. Reality, look into it.

 

[Dr Grump]

One heart, two recipients. Older person has been on the waiting list for 5 years; younger patient has been on the list for 6 months.

Who gets the transplant?

Person on the list the longest. First come, first serve.

Why should it be first come first served? How about who needs it most?

They both 'need it most'. Why shouldn't it be whoever has been waiting the longest?

Not true. One's condition might be a lot more serious than the others. Some people who need heart transplants can be kept going by an array of drugs while others need more immediate attention...

 

[WillowTree]

At times, medicine is about playing "god" and making decisions. No one is EVER always going to be 100% happy with the decisions made.

And, as long as the government practices discrimination neither I nor any of my family members will participate in that discrimination.

so you nor your children will neither be organ donors nor recipients?

two of my kids are 50, so they won't be getting anything, t