More seniors stepping forward to donate kidneys

Donors include healthy adults in their 60s and 70s

Kaiser Health NewsFebruary 4, 2013 

HEALTH DONORS30

At 74, Robert Brown donated a kidney to his wife, Sue, then 71; complications from the procedure proved to be manageable. Illustrates HEALTH-TRANSPLANTS (category l), by Judith Graham, (c) 2013, Kaiser Health News. Post. Moved Wednesday, Jan. 30, 2013. (MUST CREDIT: Washington Post photo by Michael S. Williamson.)

MICHAEL S. WILLIAMSON — THE WASHINGTON POST

Robert Brown was healthy, willing and a good match: So why not give a kidney to his wife, who otherwise would need dialysis?

There was just one potential obstacle: Brown was 74, an age once unthinkable for a kidney donor.

For this retired psychologist from Columbia, Md., that wasn’t an issue. “I didn’t think about the age thing, not at all,” Brown said about his decision two years ago to offer a kidney to his wife, Sue. She was 71 at the time and ill with Fabry disease, a rare genetic disorder that can lead to a harmful buildup of fat in the kidneys.

For the Browns’ physicians, what counted was the couple’s physiological age – how healthy and strong both of them were – rather than their chronological age.

“We feel very strongly that healthy older adults should receive organ transplants and be considered as organ donors,” said Dorry Segev, an associate professor of surgery at the Johns Hopkins University School of Medicine, whose colleagues operated on the Browns.

Many of the nation’s transplant centers agree, at least in part. More than half of them do not have upper age limits for kidney transplant recipients.

But physicians are conservative about living kidney donors: Nearly three-quarters of transplant centers have not accepted organs from people older than 70, according to Johns Hopkins research.

Caution makes sense because the long-term effects of kidney donation on older adults are unknown, Sameh Abul-Ezz, a professor of nephrology at the University of Arkansas for Medical Sciences, noted in a 2010 commentary in the journal Kidney International.

In 2011, 96 people age 65 and older served as living kidney donors in the United States, according to data from the United Network for Organ Sharing, which manages the nation’s transplant system. Between 1990 and 2010, 219 men and women between the ages of 70 and 84 donated kidneys, according to an article published in 2011 by Segev and colleagues.

Data about medical outcomes when using older kidneys, while relatively scarce, are encouraging. In his 2011 study, Segev found that 93 percent of patients who received kidneys from live donors 70 and older were alive one year after transplant surgery, and 74.5 percent survived five years. As for patients who got kidneys from live younger donors, 96 percent were alive at one year and 83 percent at five years, a result considered statistically equivalent.

These and other good results “argue for the expansion of older living-donor transplantation because this may represent an important solution to the organ shortage,” Kapur and his colleagues concluded.

But other transplant experts such as Abul-Ezz are less sanguine, citing evidence that raises red flags.

In one analysis of 12 clinical studies, patients who received kidneys from older living donors were less likely to be alive five years after the operation than patients transplanted with kidneys from younger donors. Also, organs that came from older living donors were more likely to fail during this time period than those from younger donors.

Then there is the reality that surgery can present additional risks for older patients; this requires physicians to be especially careful about whom they deem fit to undergo transplant procedures.

“Evaluating patients in their 70s for receiving or donating a kidney is one of the most difficult things we have to do. Fifteen years ago, we wouldn’t have even seen these patients,” said Gabriel Danovitch, medical director for the kidney and pancreas program at Ronald Reagan UCLA Medical Center.

There’s no question about the burgeoning need for kidneys. Almost half of the 871,000 Americans with advanced kidney disease are older than 65, and rates of chronic kidney disease in this age group more than doubled between 2000 and 2008, according to the National Institutes of Health.

The harsh reality is that more than half of kidney transplant candidates over the age of 60 will die before receiving an organ from a deceased donor, researchers estimate.

That is why such experts as Kapur, Segev and Mikel Prieto, surgical director of the kidney and pancreas transplant program at the Mayo Clinic in Rochester, Minn., are trying to broaden the pool of potential living donors to include adults in their 60s and 70s.

Studies indicate that 10 to 20 percent of seniors who need a transplant would find living donors, many of them among people of their own age, if they looked, Segev said.

But many doctors don’t believe this is a reasonable option, and many patients don’t believe they could be good candidates.

Although older kidney donors haven’t been studied extensively, a handful of reports suggest that this surgery is safe and complications are relatively uncommon when donors are carefully selected.

“It’s very common that patients in their 70s want to donate. It’s less common that they are fit to donate,” said Prieto. Anyone with a history of heart disease, stroke, diabetes, cancer, cognitive impairment and several other conditions common in older people is excluded from donation. Often, a host of minor medical issues that might seem insignificant individually will also disqualify a prospective elderly organ donor, he noted.

Like Robert Brown and his wife, Shirley Hall and her brother-in-law Hilding “Joe” Johansson did not see age as an impediment to transplant surgery. Hall, who divides her time between Howard, S.D., and Apache Junction, Ariz., is 75. Johansson, of Sioux Falls, S.D., is 71.

Johansson has polycystic kidney disease, and over 15 years he had two operations to remove growths on his kidneys.

After donating a kidney to Johansson at the Mayo Clinic last fall, Hall felt “a little bit of pain” but not enough to take the medication doctors ordered. Several months later, she said, “I’m feeling great.” Johansson said he has a lot more energy and is looking forward to traveling and bow hunting in the year ahead.

After his September 2010, surgery at Johns Hopkins, Robert Brown developed an infection at an abdominal incision made to remove his kidney. But it responded to topical treatments, and several weeks later he began exercising again.

Sue Brown’s post-transplant medication regimen made her “unbalanced” and “lightheaded” and it had to be adjusted over the course of several months, but looking back over the experience, she said she was convinced that it was a “good decision.”

“We’re taking great care of each other, and I appreciate that,” she reflected, noting that their 50th wedding anniversary is coming up this year. “For one thing, I know he loves me and enjoys being with me and doesn’t want to get rid of me.”

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