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Kidney Donor Pool Expands with Living Kidney and Paired Donation Programs

The need for kidney donors is greater today than ever before. The gap between the number of kidney donors and the number of people on the waiting list continues to grow, says Clifford Miles, MD, nephrologist at Nebraska Medicine.

In 2012, there were almost 100,000 people on the kidney transplant waiting list while there were only about 16,000 transplants performed. It is estimated that approximately 4,500 people on the waiting list die each year.

Directed living kidney donation and kidney paired donation are two donor options that doctors hope will help close that gap.

"Evidence over the last 20 years shows that patients who receive kidney transplants from living donors have the best outcomes," says Dr. Miles. "Patients who receive a deceased donor kidney can expect the kidney to function for 12 to 15 years, while a living donor kidney has an average life of 14 to 18 years. However, our pool of living kidney donors peaked in 2004 and has steadily decreased over the last 10 years."

Part of that may be due to the rise in obesity, diabetes and high blood pressure in this country, which can make a potential donor unsuitable for donation, notes Dr. Miles. Another barrier to donation by a living donor has been incompatibility, but that is no longer the case.

Clifford Miles, MD, nephrologist
Clifford Miles, MD

"The introduction of the Kidney Paired Donation Program creates a network of donors between multiple medical centers that allows us to find matches for incompatible pairs," he says. "Think of it like donating blood. You are donating to a large pool, instead of to a specific person. There is a lack of awareness about this program among doctors and their patients."

Nebraska Medicine is part of the paired donation network operated by the United Network for Organ Sharing (UNOS) which includes a network of more than 150 medical centers.

"The Kidney Paired Donation Program opens more opportunities for a donor to help a loved one through an indirect donation," says Ketki Tendulkar, MD, nephrologist at Nebraska Medicine. "The use of desensitization protocols can help decrease complications associated with incompatibility, but over the long term, these transplant recipients do not fare as well. The Kidney Paired Donation Program not only helps these individuals receive a more compatible living donor kidney, but also helps others on the list not fortunate enough to have a living donor.

The main goal of this exchange program is to reduce the number of people on the transplant waiting list, while maximizing good outcomes for recipients. The primary care doctor is the one whom a potential donor will go to first with their questions so we encourage open discussion about all options available. Our donor team also is available to discuss these options and answer questions from potential donors and their primary care providers."

"Living kidney donation is very safe for the donor," notes Dr. Miles. "We have not seen a higher risk for dialysis, a need for a transplant or premature death. However, donors do a have a higher risk for developing high blood pressure and decreased kidney function over time."

Dr. Miles stresses the need to reach patients before they need dialysis. "The best outcomes are achieved in patients who receive a transplant before they require dialysis," he says. "The pros and cons of kidney transplantation should be addressed with the patient when they reach stage four of chronic kidney disease or about 25 percent kidney function. If transplantation is an option they want to consider, the patient should be referred to a transplant center where the evaluation process to determine if they are a candidate can begin."

Early stages of chronic kidney disease often do not cause noticeable symptoms and patients are commonly diagnosed while being evaluated for something else. Symptoms of more advanced kidney disease include: fatigue, loss of appetite, itchy skin and difficulty sleeping. Laboratory investigation may show high potassium, high phosphorus, anemia and acidosis. "We would prefer to see the patient before these signs and symptoms have developed," says Dr. Miles.

Dr. Miles says communication is key through the entire evaluation and transplant process. "We work hard to keep the referring doctors in the loop and encourage them to maintain follow-up care with their patient after the transplant and resume their role as the primary provider of care."