INTERNATIONAL ORGAN DONATION AWARENESS -UNITED KINGDOM
Kidney transplant revolution gives hope to dying patients
Previously rejected kidneys get clean bill of health for donation as study embraces use of organs after cardiac death
Hundreds of lives a year will be saved if the NHS embraces a transplant revolution involving patients receiving donated kidneys that were previously rejected as inadequate, doctors claim today.
Since the 1970s almost all kidney transplants using organs from the deceased have come from "brain dead" donors, who have typically been involved in a car crash, brain haemorrhage or severe head injury in a fall or industrial accident. But the supply of available organs from such people is declining, not least because there are fewer deaths in road accidents.
In an attempt to tackle this, and reduce the 700 or so deaths a year caused by the UK's acute shortage of donated kidneys, surgeons at several NHS hospitals have been pioneering the use of kidneys from people who have died from major heart failure following severe brain injury.
The orthodox view has been that DCD – donation after cardiac death – kidneys are far inferior to those from "brain dead" donors. But research published today in the Lancet shows that kidneys from either source are equally good at prolonging the life of patients whose condition would otherwise kill them.
The surgeons behind the study say their findings should help persuade colleagues, many of whom have been reluctant to use DCD kidneys for fear that they would fail.
Other NHS hospitals are now expected to set aside their traditional lack of faith in that technique.
Patients with chronic kidney failure make up about 7,000 of the 8,000 people on the UK-wide transplant waiting list of those seeking one or more organs, including a new liver, kidneys, heart or even lungs.
The UK has one of Europe's lowest rates for donation of organs, including kidneys, and about 1,000 patients die every year because of the shortage.
"I don't think it's unrealistic to suggest that the widespread use of these [DCD] donors could double the national kidney donation rate," said Dr Dominic Summers, one of the co-authors of the Lancet study and a transplant surgeon at Addenbrooke's hospital in Cambridge.
Some 2,500 people a year undergo a kidney transplant, of whom 1,600 receive an organ from a dead person and the other 900 from a living donor – a relative, spouse or friend. Extensive use of DCD kidneys by hospitals could see those 1,600 operations soar to as many as 3,200, said Summers. "The widespread use of this technique will save lives. I would say that hundreds of lives could be saved if this trend continues across the NHS."
Professor Andrew Bradley, the study leader who also works at Cambridge University and Addenbrooke's hospital, said: "Cardiac-death donors represent an extremely important and overlooked source of high-quality donor kidneys and have the potential to increase markedly the number of kidney transplants performed in the UK."
The Lancet study looked at the health outcomes for 9,134 patients who received a kidney in one of 23 transplant centres between January 2000 and December 2007. Of those, 8,289 received a kidney donated after a brain death and the other 845 from a cardiac-death case. It found that both types of organ were just as good at agreeing with the patient and keeping them alive for at least five years.
The findings may help to banish the concern among transplant experts that DCD kidneys are inferior those from brain-death cases.
"What we have shown, for the first time, is that cardiac-death donor kidneys last as long and work as well as brain-death donor kidneys, and should be regarded as comparable," said Summers.
The two centres which have made most use of DCD kidneys, in Cambridge and Plymouth, have managed to push their rates of organ donation up to around 25 donors per million people, which is well above the UK average of 14.9 per million. Both use more DCD kidneys than brain death organs.
Professor James Neuberger, associate medical director of organ donation and transplantation at the NHS Blood and Transplant agency, said: "Donation after cardiac death is not a substitute for donation after brain stem death, but another way that organs can be retrieved, particularly kidneys, but also livers and, in a small number of cases, lungs. The process enables even more people to have their wish to donate fulfilled."
The lucky patient
Francesca Crozier, 65, a retired fashion designer, suffered from chronic kidney failure for seven years before undergoing a transplant at London's Royal Free hospital two years ago.
"I was diagnosed in 2001 with chronic liver failure. I had high toxicity in my kidneys, which meant that they were failing fast. I went on hemodialysis within three months and, in 2005, went on to the transplant waiting list.
I was lucky. I got a new kidney two and a half years later, from a woman about my age. I was never told how she died. Some people never get one and die.
Life on dialysis was terrible. I had to have three four-hour sessions a week and could only drink half a litre of liquid a day and couldn't go some places on holiday, such as America, as I couldn't get dialysed there. My donated kidney has given me my life back.
I think that using organs from cardiac-death patients is terrific, because it will provide more kidneys and save more lives."