Are promises made to living donors being upheld?

A new study finds some shortcomings by the transplant community in providing prompt access to transplantation for living kidney donors who later develop kidney disease and need a transplant. Donors are told that they will have priority for transplantation if they ever need a kidney, so any delays in providing this access must be addressed. The study's results appear in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN).

Jennifer Wainright, PhD (United Network for Organ Sharing, or UNOS) and her colleagues examined how consistently living donors get transplant priority in a timely fashion, using information from the Organ Procurement and Transplantation Network (OPTN), which includes data on all donors, wait-listed candidates, and transplant recipients in the United States. UNOS is the private, non-profit organization that manages the nation's organ transplant system under contract with the federal government..

Among the major findings:

• There were 210 prior living donors added to the OPTN kidney waiting list between January 1, 2010 and July 31, 2015.
• As of September 2015, 167 of the donors received deceased donor transplants, 6 received living donor transplants, 2 died, 5 were too sick to transplant, and 29 were still waiting.
• Median waiting time to receive a deceased donor transplant for prior living donors was 98 days.
• Only 40.7% of the donors were listed before they began dialysis; 68.3% were in inactive status, which means they were not eligible for organs, for <90 days, 17.6% for 90-365 days, 8.6% for 1-2 years, and 5.4% for >2 years.
• Median time for prior living donors waiting in active status before receiving priority was 2 days; 67.4% received priority within 7 days after activation, but 15.4% waited 8-30 days, 8.1% 1-3 months, 4.1% 3-12 months, and 5.0% waited >1 year in active status for priority.
• After receiving priority, most were transplanted quickly, and the median time in active status with priority before deceased donor transplant was 23 days.

"We found that most prior living kidney donors on the kidney waiting list are transplanted quickly, but some spend periods of time waiting in inactive status. Others wait weeks or months on the waiting list without priority access, which must be requested by their transplant hospital," said Dr. Wainright. "UNOS has developed procedures and education that aims to reduce these delays in the future."