September 24, 2022

Transplant surgeons ignoring long-term health of US donors

Although almost half of the people who donate organs in the US are living donors, there has been no systematic tracking of their health to assess the risks they are running, the St Louis Post-Dispatch claims in a series of scathing reports. As well, since the government does not regulate transplants from living donors, hospitals make their own rules about who qualifies to be a donor. In some cases, children as young as 10 have donated kidneys — most of their beneficiaries were adults, some in their mid-50s who were suffering from diabetes. "There is no system and there is no accountability," says bioethicist Arthur Caplan.


Without donor follow-up, it is difficult to draw an accurate picture of their health. But the head of the kidney transplant program at Fairview University Medical Center in Minneapolis, Dr Arthur Matas, says that 3 out of every 10,000 kidney donors die and about 10% develop complications. Some kidney donors later need a kidney transplant themselves. "You are not mandated to report to any agency when you have a donor complication," said Dr. David C. Cronin II, director of liver transplantation at Yale-New Haven Hospital in Connecticut. "Who knows how many are occurring, really?"


What angers relatives of donors who died or developed complications is that they had not appreciated the risks involved. Dr Cronin agrees, saying that informed consent by a donor is "fictitious". "Now we’re going to bring in a lay person of various degrees of education and we sit in an office for 20 minutes, half hour, and we try to impart on them years of experiences, years of risk analysis, years of statistical likelihood of what will occur, and they say: ‘OK, sign me up.’ Some would say that’s informed consent. It’s really not — you had a discussion. Thank God you at least had a discussion."


However, the lack of data has not stopped transplant specialists from pushing back the boundaries of eligibility. Faced with a growing shortage of organs, they are increasingly willing to accept donations from children as young as 10, people with high blood pressure, drug addicts, mentally ill people and even people who might be illegally selling their organs. At least one centre is willing to accept organs from 90-year-olds.


"If we say, we’ll do the best cases — people at lowest risk, donors with no disease at all — we won’t do very many transplants," said kidney specialist Dr Stephen Textor of the Mayo Clinic in Rochester, Minnesota. "It’s a situation where people in organ failure are on their way to death. The question is: how far are we willing to go to help them get back on track to be well?"