Organ transplants: Older organs used, with patients' consent

Organ transplants: Older organs used, with patients' consent
With organs in short supply and need growing -- especially among older patients -- doctors turning to previously discarded organs


By Deborah L. Shelton Tribune reporter
September 18, 2009

At 84 years old, Juan Guano would seem an unlikely candidate for a kidney transplant.But consider this: The kidney he received was 69.Until recently, that kidney would not have been eligible for use in a transplant, because of the age of the deceased donor. But this summer, surgeons at Northwestern Memorial Hospital transplanted it in Guano, who is among the nation's oldest organ recipients.His surgery illustrates two intersecting trends in transplant medicine: People 60 and older represent the fastest-growing age group on transplant waiting lists, and kidneys increasingly are being accepted from older people and donors who had health problems.Organs from these "expanded-criteria donors," which otherwise would be discarded, can give patients such as Guano a new lease on life. Guano, a grandfather of five and great-grandfather of six, beams as he recalls being summoned to the hospital on Father's Day for surgery. The octogenarian had undergone six years of dialysis after his kidneys failed. "I was surprised; I was shocked," Guano said in Spanish as he relaxed in the sunny living room of his art-filled Logan Square home, surrounded by three of his four children. "I still can't believe it."Some experts have expressed ethical concerns about using less-than-perfect kidneys for transplants, stressing the need for full disclosure to the recipients."The primary reason [for using these kidneys] is to try to get the most out of the existing organs to save lives, but another factor is that transplantation is lucrative," said Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania. "We have a lot of programs doing transplants, clearly more than the supply of organs justify," he added. "That means people want to save lives but they also push hard to try to use organs of somewhat questionable quality. ... Even an 84-year-old needs to know that [surgeons] are talking about a kidney that they had reservations about."More than 16,000 kidney transplants were performed nationwide last year, and the current waiting list for kidneys stands at about 81,000. The use of expanded-criteria kidneys has increased about 30 percent since 2002 and now accounts for about 11 percent of all kidney transplants.Guano got his kidney through Northwestern's Hispanic Transplant Program. Dr. Juan Carlos Caicedo, the program's director, said that of the almost 3,000 kidney transplants performed by Northwestern since 1988, 188 came from donors 65 or older."Part of our informed consent process -- and it's very thorough -- is to explain to every patient all the risks and benefits, and they have the last word," he said.Patients who accept an expanded-criteria kidney have a shorter wait for an organ and are less likely to die than patients on dialysis. In the Illinois region, the average wait for a kidney is five years. A recent study published in the Clinical Journal of the American Society of Nephrology found that about half of kidney transplant candidates older than 60 will die before getting a deceased-donor kidney.