Unrelated living donors in the United States have increased to the point where they were the most common category in 2009, most likely because of swaps and chains, said Gabriel Danovitch, medical director for the Kidney and Pancreas Transplant Program at the University of California, Los Angeles.
The total recipient pool reflects the populations undergoing dialysis; white persons form the largest category, followed by African American, Hispanic, and then Asian persons. But the donor pool reflects the demographics of the national population, meaning that African American and Hispanic individuals are overrepresented recipients and underrepresented donors. Danovitch believes that this largely follows economics: chronic kidney disease is common in the poor, and uninsured donors are unacceptable at many transplant centers.
Interestingly, there has been an increase in living altruistic, or “Good Samaritan,” donors, who tend to be older, wealthier, and highly educated. In 2009, there were 141 living altruistic donors, and the numbers have been increasing each year.
Speaking of these donors and the chains they help start, Danovitch said, “I do believe this can change the whole scene of living donor transplants in this country. It has unanticipated benefits, including an impact on the deceased donor waiting list, and it replaces the medical angst of performing high-risk transplants with bureaucratic angst [of coordinating chains]—and doctors always prefer this to medical angst.”
Other benefits include more income for hospitals, a positive impact on staff morale, and the publicity that chains receive, which can act as a catalyst for more living and deceased donations.
He noted that although shipping kidneys across the country still makes him nervous, the kidneys “do well and open up straight away.” He pointed to the Netherlands, which invested in a national living donor exchange program a decade ago and as a result has decreased its waiting list by almost one third. Danovitch said, “I see no reason why, in principle, we cannot do the same thing with national promotion.”
Garet Hil, president and founder of the National Kidney Registry, presented the talk, “Donor Swaps: A Review of the National Kidney Registry Chains,” aat Renal Week 2010.