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Who should get the new kidney? A panel is trying to decide Date published: 3/25/2007
EXACTLY HOW do you place a UNOS is a nonprofit group tasked with setting national organ distribution policy under government contract. As a recent Wall Street Journal article about kidney transplants pointed out, in general the patient whose name has been on the list the longest in each region of the country gets dibs on the next available organ. But what if the recipient list is topped by an elderly patient nearing the end of his life, while a 20-something with plenty of years left languishes near the bottom? Is giving the kidney to the older patient the best use of a scarce resource? Today, more than 70,000 people await new kidneys (by far the most common form of transplant). About 4,000 die each year without receiving an organ. In 1999 the Department of Health and Human Services ordered UNOS to restructure its allocation modality, placing more emphasis on "best use" criteria and de-emphasizing simple length of time on waiting list. This prospect has left older patients concerned. The rationale is simple. The success of an organ transplant is generally measured in terms of "life years gained." With research showing that recipient age is the major factor in the success of kidney transplants, UNOS has targeted that factor as a primary "best use" criterion. For example, according to the Scientific Registry of Transplant Recipients, a typical 25-year-old diabetic will gain an extra 8.7 years of life from a kidney transplant, while a 55-year-old diabetic will reap only 3.6 years. Therefore, according to the "best use" concept, the kidney should go to the younger recipient. But what if the 55-year-old is the president of the United States? Or a world-class surgeon? Or a child's beloved grandfather? How exactly do you figure in those factors?
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