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Ed Kraus, M.D., talks to ECD |
John Coppinger’s first kidney transplant worked like a charm—for a dozen years. Then kidney disease returned with a vengeance. When Hopkins nephrologist and associate professor of medicine Ed Kraus, M.D., told him about expanded donor criteria (ECD) organs as a way to speed the receipt of a cadaveric kidney, he listened intently.
“Patients need to consider how they are doing when the organ becomes available,” explains Kraus. “If they are doing well, they may want to be more selective. On the other hand, if they are doing poorly on dialysis and are having vascular access problems, compromising the efficiency of their dialysis, they may want to consider an ECD organ.”
By agreeing to an ECD kidney, Coppinger knew he would feel better after surgery. His first transplant was successful; he knew how much better he felt as a result. “I hated the way I felt on dialysis,” reflects Coppinger. Transplanted again in June 2003, he adds, “I knew there were more risks this time, but I was willing to take them.”
The patient’s ECD decision should consider these statistics: the national kidney waiting list is 56,000. The list grows by about 2,500 annually. Only about 8,000 deceased donor kidneys become available each year for transplant. More than half of all patients awaiting a kidney will wait more than three years.
The United Network for Organ Sharing (UNOS) recognized listed patients wanted kidneys from younger, healthier donors, even if it meant waiting longer.
UNOS found that older donor kidneys or kidneys from donors with medical conditions (hypertension, death due to stroke or impaired kidney function at the time of death) were often not used. UNOS labeled these organs ECD kidneys.
ECD kidneys have a 70 percent higher chance of not working post transplant than other donated kidneys. In other words, the patient’s chance of needing dialysis after three years is 30 percent if an ECD kidney is used, rather than 20 percent with a non-ECD cadaveric organ.
Research suggested that individuals on the waiting list could be transplanted faster if UNOS created a sub-category of patients who would consider accepting ECD organs. UNOS now mandates that patients consent to be listed for an ECD organ so that when these organs become available, they can be more rapidly placed with a suitable candidate.
Patients who may not have considered ECD kidneys would now be encouraged to think about the option. The new rule does not mean that patients must accept the ECD organ when it becomes available, even if they are listed for one.
“Potential recipients have the right to know the kidney donor’s age, cause of death, and other health concerns,” says. Dr. Kraus. “I tell my patients all the time, ‘you have the right to say no if you feel uncomfortable about accepting a kidney after hearing about the donor when the opportunity arises for a transplant. You will not be penalized, nor will your place on the list be jeopardized.’”
To update your ECD consent status, please contact your renal transplant evaluation coordinator.
