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Organ donors and recipients are aging

Submitted by on 24 November, 2020 – 4:32 pm
At 84 years of age, John Guano seems a candidate for a kidney transplant.

But consider this: The kidney he received was 69.

Until recently, the kidneys would not have been eligible for use in a transplant due to age of the deceased donor. But this summer, surgeons at Northwestern Memorial Hospital transplanted in Guano, making it among recipients of organs oldest in the country.

Operation reveals two trends intersect in transplantation medicine: Persons 60 years represent the fastest growing group in the age of the transplant waiting lists, and kidneys are increasingly being accepted for the elderly and donors who had health problems before he died.

The bodies of these “expanded criteria donor”, which would otherwise be discarded, can give patients as Guano a new chance at life. Guano, a grandfather of five and grandfather of six, including beams, recalls being summoned to the hospital on Father’s Day for surgery. The octogenarian had undergone six years after his kidney dialysis.

“I was shocked, surprised me,” Guan said in Spanish as he relaxed in the sunny living room of his art-filled home, surrounded by three of her four children. “I still can not believe it.”

Some experts have expressed ethical concerns about the use of less-than-perfect kidney transplantation, emphasizing the need for full disclosure of the beneficiaries.

“The main reason (to use these kidneys) is trying to get the most out of existing organs to save lives, but another factor is that the transplant is lucrative,” said Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania .

“We have a lot of programs doing transplants, clearly more than justify the supply of organs,” he added. “That means that people want to save lives, but also push hard to try to use the organs of questionable quality. … Even a 84-year-old needs to know that (surgeons) is a kidney that had reservations about” .

More than 16,000 kidney transplants were performed last year nationwide, and the current waiting list for kidneys is about 81,000. The use of expanded criteria kidneys has increased about 30 percent of the accounts since 2002 and now nearly 11 percent of all kidney transplants.

Guano received his kidney through the Northwest Transplant Program Hispanic. Dr. Juan Carlos Caicedo, program director, said of the nearly 3,000 kidney transplants performed at Northwestern since 1988, 188 were from donors 65 years.

“Part of our process of informed consent – and is very complete – to explain to all patients all the risks and benefits and have the last word,” said Caicedo. “They can decide whether they want or do not.”

Patients who accept an expanded criteria kidney have a shorter wait for an organ and are less likely to die than patients on dialysis.

A recent study published in the Clinical Journal of the American Society of Nephrology found that about half of renal transplant candidates over age 60 die before receiving a kidney from a deceased donor. The risk of dying before transplant was even greater for African Americans, diabetic patients who are 70 years or older and those with blood type B or O.

The downside of taking an extended criteria kidney instead of a normal kidney is at increased risk of organ rejection and death.

“What we’re trying to do is have the best relationship between donor and recipient,” said Caicedo. “We want to transplant kidneys from young donors in the elderly, or vice versa. We want the party to have the best outcome, ensuring that the patient and kidney have the longest survival. In this case, we were able to use an expanded criteria kidney would probably not be good for 20 years of age. And a kidney that was used in many cases have been discarded or unused. ”

Guano received the kidney had been offered to others, who rejected it. Not knowing how long they would have to wait if he said no, Guano reminds doctors saying, “Yes, I take it.”

Between 1988 and late June, nine people have 86 years or more kidney transplants from a deceased donor in the U.S., received two kidneys from living donors. I’m still waiting for about 150 people between 81 and 85, and about a dozen people 86 years or more.

The transplant waiting list is aging, because people are living longer and developing conditions such as diabetes and hypertension that lead to chronic diseases and eventually end stage organ failure, said Dr. John Friedewald, vice president of the commission for the allocation of kidneys from United Network for Organ Sharing, which oversees the transplant system in the nation.

However, the donor is much younger, he said, creating a mismatch.

There is no automatic cutoff age in the waiting list for a kidney. Transplant centers deciding who to add to the list and donor bodies to accept, and the criteria they use vary, said Dr. Robert Higgins, chairman and president of UNOS heart transplant at Rush University Medical Center.

Guano daughter Sonia said several hospitals in Chicago had turned him away, but his family continued to search.

Older people often have more risk factors that can complicate surgery, including hypertension, diabetes, obesity and arteriosclerosis. But in general, were discarded for transplantation solely on the basis of age.

“You might be a young man of 65 or may be an ancient 25 years old,” said Caicedo. “Sometimes you have a 65 – to 70-year-old patient’s mental attitude is very young in spirit and attitude and may have multiple medical problems, but they are motivated. … It is so important here. It is not chronological age .

Guano went home two days after transplantation. Two days later, returned to work in his series of 12 sculptures of Christian inspiration, called “Los Hijos del Sol” or “Children of the Sun.” A retired furniture factory and consummate sculptor, emigrated to the U.S. from Ecuador 33 years ago and became a citizen of a dozen years ago.

On a recent day, Guano talked about his working life as a clay model was a sculpture of their living room simply decorated, decorated with lace curtains, family photos, several figures of Santa Claus and a flag Ecuadorian children. He was animated as he spoke of his desire to exhibit his art and one day meet his donor family.

High blood pressure destroyed their original kidneys. But Guano health was otherwise good before transplantation. Castro said that a transplant was offered a better quality of life than dialysis, and possibly a longer life.

“I was in good shape,” said Caicedo. “I could live five, 10 years.”

Medicare, which pays for surgery for Guano, covers the cost of the transplant if the patient is over 65 years, including anti-rejection drugs.

Higgins said Northwest should be applauded for the use of expanded criteria kidneys to expand the donor pool.

“Longer term, we know that for any patient with a transplant is better than staying on dialysis,” he said. “The question that arises in a limited environment cost is the cost of health care should be used in situations like this. That’s a broader issue which I think is in the medical community and regulatory and on the side of the formulation policies, and is not a simple answer. “

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