Potential Yield of Imminent Death Kidney Donation

Ryan A. Denu; Eneida A. Mendonca; Norman Fost

Disclosures

American Journal of Transplantation. 2018;18(2):486-491. 

In This Article

Abstract and Introduction

Abstract

About 99 000 people are waiting for a kidney in the United States, and many will die waiting. The concept of "imminent death" donation, a type of living donation, has been gaining attention among physicians, patients, and ethicists. We estimated the number of potential imminent death kidney donors at the University of Wisconsin Hospital and Clinics by assessing the number of annual deaths in individuals with normal kidney function. Based on a previous survey suggesting that one-third of patients might be willing to donate at imminent death, we estimate that between 76 and 396 people in the state of Wisconsin would be medically eligible and willing to donate each year at the time of imminent death. We extrapolated these numbers to all transplant centers in the United States, estimating that between 5925 and 31 097 people might be eligible and willing to donate each year. Our results suggest that allowing donation at imminent death and including discussions about organ donation in end-of-life planning could substantially reduce the nation's kidney waiting list while providing many more donors the opportunity to give this gift.

Introduction

More than 120 000 adults and children are waiting for an organ in the United States, and another patient needing an organ is added to the transplant list about every 10 minutes. The organ in highest demand is the kidney, with approximately 99 000 people waiting, 30 000 new patients added to this list every year, and 4500 who die on this list every year. The incidence of end-stage renal disease (ESRD) has been increasing and represents a significant public health and economic burden, as nearly 900 000 Americans are being treated for ESRD and more than 20 million have some form of chronic kidney disease (CKD).[2] Treatment of ESRD requires either dialysis or kidney transplantation. Kidney transplantation is the most effective therapy for kidney failure,[3] and its benefits over dialysis include significantly better quality of life, fewer medical complications, and longer survival.[3–5] Transplantation is more cost-effective than dialysis.[6,7] Successful kidney transplantation to candidates awaiting transplants could save $10 billion per year (approximately $55 000 per year for the life of every functioning transplant).[8] Despite the benefits of transplantation over dialysis to treat ESRD, rates of living kidney donation have decreased in recent years.[9] To save lives while potentially decreasing health care expenditures, there is a need to increase the number of kidneys available for transplant.

Currently, organ transplant policy and laws in the United States allow for organ procurement from 3 sources: donors with neurologic deaths, donors with controlled circulatory deaths, and live organ donors. Past efforts to increase donors have focused on education campaigns, typically encouraging people to sign up to be a donor when getting their driver license. However, these campaigns quickly lose impact over time[10] and have not focused on increasing living donation.

Some individuals with terminal illness wish to donate their kidneys shortly before they die—at the time of imminent death[11]—but there has not been a single reported case of kidney donation at the time of imminent death (ie, before the imminently dying patient has been declared "dead"). The ethical and legal dimensions of imminent death donation (IDD) have been addressed elsewhere.[11–18] The purpose of this report is to provide an estimate of the number of potential annual kidney donors in the United States if IDD were to become available. We estimated the number of potential IDD kidneys at the University of Wisconsin Hospital and Clinics by assessing the number of annual deaths in individuals receiving end-of-life care with apparently healthy kidneys. We extrapolate these numbers to other hospitals with transplant centers in the United States. Our results suggest that allowing donation at imminent death and including discussions about organ donation in end-of-life planning could substantially reduce the nation's kidney waiting list.

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