Transplant experts debate the creation of a nationwide registry for paired donations

BY JENNY EARL | APRIL 06, 2012 6:30 AM

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Health officials are looking to create a nationwide registry for kidney donations — and University of Iowa Hospitals and Clinics doctors are weighing the benefits.

Leaders in kidney transplant research announced last week that creating a nationwide registry used to oversee paired kidney donation would increase patient chances of receiving kidneys from live donors. Hospitals under the registry — such as the UIHC, which established its own in 2000 — would join with the programs of other hospitals.

"There's plusses and minuses to a national registry," said Alan Reed, the UIHC director of transplant and hepatobiliary surgery. "More people, more matches. But [there may be] less innovation and local interest and things like that."

In paired exchange donation, a transplant candidate with a willing donor who is incompatible can exchange donations with another candidate and her or his willing donor, providing a suitable match for each patient. Though it has been nearly a decade since the paired exchange program was created nationwide, there is currently no uniform system among hospitals for these exchanges.

According to the Scientific Registry of Transplant Recipients, about 9 percent of patients on kidney transplant waiting lists at UIHC and Iowa City VA Medical Center — where the same surgeons perform surgeries at both locations — received a kidney from a living donor from 2010 to 2011.

"Traditionally, [living transplant donations] have occurred when somebody has stepped forward to donate a kidney to a loved one," Reed said. "That's sort of a traditional way that they're done, given by a father — brother — that's still a huge bulk of how these transplants get done."

But Reed said a relatively small percent of transplants at the UIHC are done through paired donation.

Ken Andreoni, associate professor of surgery at Ohio State University — who attended the national conference that discussed creating the national unified program — said a national registry would mathematically increase the number of transplants in the long term.

"The more people you have in a system, in a big pool, the more chance [you'll have] of finding the needle in the haystack," he said.

Andreoni said the number of living donors has increased since the creation of the Kidney Paired Donation Pilot Program in 2000. He estimated around 460 or 500 additional transplants have been completed in the last year from this living exchange system.

"The world's best scenario is to have enough deceased donors. We never want to put a person under the risk of having to donate their kidney," Androni said. "With that said, there's really not enough, and people don't live as long on dialysis as they do with a transplant — and you live longer with a live transplant."

Anne Paschke, a spokeswoman for the United Network for Organ Sharing, said the organization is asking for public feedback to turn the operating guidelines of the Kidney Paired Donation Pilot Program into national policy. After the committee receives public feedback, it will make necessary changes and put the policy toward the network board for a vote in November.

"At that point, it would no longer be a pilot program," Paschke said. "That doesn't mean any other program would cease to exist — it would be permanent."

The policies would go into effect in February, she said.

"There's going to be a lot of people with different opinions," Andreoni said. "At least this gets together a number of people from different areas to discuss what's working, what's not working, and where things should go in the future."

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