National Network Allows More Successful Kidney Transplants
Another finding of the new study was that HLA-matched kidneys given to black recipients who had high blood pressure lasted only half as long as they did in black recipients with other causes of kidney failure.
"This study shows that not even matched grafts work very well in blacks, especially those with [high blood pressure]. We need to work on improving outcome in this group," says Charles F. Shield, MD, who reviewed the study for WebMD. Shield is director of organ transplantation at Via Christi-St. Francis Hospital in Wichita, Kan.
People with unusual tissue types have more difficulty in getting a matched kidney. Only 3% of black patients in TheNew England Journal of Medicine study received a matched kidney, as most donors were white, and black patients tend to be more difficult to match for HLA markers.
"To add some justice to the system, we factor other things into the decision of who gets the kidney, such as waiting time. Children get higher priority," Cecka says. "Unfortunately, those that are on top of the list because they've been waiting the longest are often the worst candidates."
The National Allocation Program assigns a set number of points for each of the factors, then determines the best possible match, Cecka explains. Only 20% of donated kidneys find an acceptable HLA match, and the rest get transplanted locally.
The researchers note that age should be among the factors taken into consideration. Many kidneys are from older donors, which could fail prematurely in younger recipients, they say.
"We're studying alternate methods to speed up the waiting time before transplantation," Cecka says. "But the biggest problem is simply that there are more people waiting than there are available kidneys." As of Sept. 30, more than 46,000 people in the U.S. were waiting for kidney transplants, the UNOS says. And in 1999, more than 6,000 patients died while waiting for an organ transplant.
Living donors now make up almost half of kidney donations. Kidneys are donated mostly to blood relatives but also to spouses, friends, and even strangers. Lack of understanding and communication sometimes stops organ donation -- the family is always asked to approve cadaver organ donation -- and may decline unless their relative's wishes were clear.
For more information about organ donation, visit the United Network for Organ Sharing web site at www.unos.org.