By Alan Mozes
HealthDay reporter
THURSDAY, June 24, 2021 (HealthDay News) – In the world of chronic kidney disease, the dilemma is not uncommon: a relatively young patient with kidney problems may need a transplant, and an older family member is more than ready to move up. But the need for a kidney transplant, while predictable, is not immediate.
So the older donor does not act. Given that donor supply never met demand, the loss of a golden opportunity – due to age or circumstances – has long frustrated people in the kidney transplant community.
But a new study reports on a seemingly possible solution to the problem: kidney vouchers.
“It’s like a coupon that you can use in the future,” said study author Dr. Jeffrey Veale. He specializes in kidney transplants as part of the Kidney Transplant Exchange Program at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA). “And it makes a lot of sense. Especially for people of advanced age who want to be living donors – grandparents, for example – but who would have to donate immediately, even if the family member for whom their kidney is intended does not. “Need it now”.
Veale explained that donors who sign up for the voucher program are effectively giving their kidney to a stranger with an immediate need. In return, however, they will then receive a voucher, which they can then assign to the person or persons they really want to help.
In return, this patient can “pay out” his voucher at any time in the future and immediately receives a “priority status” on the donor waiting list for another living donor if he is urgently needed.
Veale said it was a UCLA patient, Judge Howard Broadman, who first proposed the idea seven years ago. Under Veale’s care, Broadman decided to donate one of his kidneys to a stranger, understanding that he could use it to “bank” a kidney for his grandson if necessary.
Kidney vouchers have encouraged “living donation”
Since then, the voucher program has expanded to 79 facilities in the United States, where the process is heavily regulated and controlled.
Kidney vouchers are given at the time of donation and are non-transferable. Each donor can give a voucher to up to five different potential recipients, including those without kidney disease. But in the end, only one of them – the first to need it – will be able to use it.
The vouchers also offer no guarantee that a kidney will actually be available immediately. They also do not advance the owner in the queue for a kidney acquired from a deceased; Only kidneys offered by other living donors will be given priority. And if the owner dies or for whatever reason is no longer eligible for a transplant, the voucher will expire.
So have kidney vouchers triggered an increase in living kidney donations?
After reviewing the data compiled by the National Kidney Registry, Veale said the answer is yes.
The register figures show that between 2014 and 2021 a total of 250 donations were made as part of the voucher program in the 79 transplant centers.
The donors ranged in age from 19 to 78 years. Almost 8% of them were over 65 years of age. Almost two-thirds were women and almost all (96%) were white as the results showed.
Better results if the kidney is from a living donor
Six recipients redeemed the voucher during the study period. Meanwhile, the transplant waiting time for those enrolled on the registry has been cut by three months, according to the report published online on JAMA Surgery on June 23.
The Veale team concluded that the voucher program does what it is supposed to: convince hesitant donors to move on, knowing their loved ones are covered.
“The idea was initially rejected in the transplant community because it really went outside the box,” said Veale. “But it’s growing tremendously. Hundreds of coupons have been completed. And it definitely makes a difference. There’s no question that the program is capable of attracting donors who would otherwise not donate.”
Given the “need for lifesaving [living] Kidney transplants far outweigh the supply, “said Dianne LaPointe Rudow, director of the living donation program in the Department of Population Health Science and Policy at the Recanati Miller Transplantation Institute at Mount Sinai Hospital in New York City.
Rudow noted that while there are about 98,000 patients on the kidney transplant waiting list, only about 39,000 transplants are performed each year. Of these, only 5,000 to 6,000 come from living donors.
“Living donor kidneys usually have better results and last longer,” she said. “You can also schedule the transplant before a patient has years of dialysis.”
While Rudow is “cautiously optimistic” about the coupon program’s ability to improve numbers, he said it was important that potential donors know the details. For example, she pointed out that as a private, not-for-profit organization, the Kidney Registry “has no federal oversight and there are no guarantees that it will exist when the person is ready for a kidney”.
“However, the voucher concept can help people feel comfortable being a living donor to a stranger, especially when they know their family is protected,” added Rudow.
More information
For more information on living kidney donation, please contact the 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 City; JAMA Surgery, June 23, 2021, online
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