Richard Formica, MD
(December 2010) Patients awaiting kidney donations have another option with a new national database that attempts to match kidney donors with incompatible recipients to reciprocal pairs in an effort to allow more patients to receive living donor transplants.
Launched in October with 77 transplant centers participating, the database is part of a broader effort to increase live kidney transplantation.
“It’s another tool in the toolbox,” says Richard Formica, MD, Yale Medical Group transplant nephrologist, and medical director of the practice’s adult and pediatric kidney and adult pancreas transplant service. He is also a member of the United Network for Organ Sharing (UNOS) kidney transplant committee that is responsible for implementing the national Kidney Paired Donation (KDP) program.
“We’ll see what happens,” Formica says. “Everyone is excited by the potential increase in the number living donor transplants. I am a little more circumspect, as the logistics of kidney swap programs are quite daunting. I do think as the pool of potential donors in the database increases, the number of swaps will go up, and I suspect this will be an exponential and not linear increase. But if you are traveling further distances, logistically those swaps will become harder. Regardless, any benefit for patients with kidney disease is welcome.”
The Yale-New Haven Organ Transplant Center already participates in the New England Paired Kidney Exchange Program (NEPKE), a regional database. Now patients awaiting organs can put their name on both the regional and national lists.
Meanwhile, Formica says it’s crucial for doctors and families to tackle the organ donor shortage from multiple angles, and continue to raise awareness about deceased organ donations. The Yale-New Haven center is the largest kidney transplant center in New England, and performed approximately 120 kidney transplants in 2010 —“dramatically more transplants” than in 2009, Formica says. He credits the rising numbers to intensive efforts to raise awareness about Yale’s living donor program by educating patients, referring physicians and the public.
Those efforts include a 30-minute educational program for potential living donor recipients developed by Sanjay Kulkarni, MD, director of the Kidney and Pancreas Transplant Service. The program teaches the importance of living donor transplantation and provides advice on broaching the topic with friends and family.
In addition, the service changed its infrastructure to support and evaluate potential living donors more efficiently. When a potential donor calls, a coordinator asks screening questions to make sure he or she is eligible, then the living donor transplant team arranges their schedule to meet and evaluate with the potential donor as soon as possible, usually within a week.
“The safety and well-being of a potential kidney donor is the overarching guiding principle of the kidney transplant service,” Formica says. “We have a truly gifted and caring group of individuals who view participation in living organ donation as a sacred privilege. No one person makes this work.”
There are 87,000 people in the United States waiting for a kidney transplant, including approximately 60,000 active cases (patients who are healthy enough to actually undergo a transplant). Slightly less than one half of the 16,000 kidney transplants performed in the U.S. each year use organs from compatible living donors, the optimal approach to transplants; the rest use kidneys from deceased donors.
There are approximately 700 patients at the Yale-New Haven Hospital Organ Transplant Center waiting for a kidney, double the number of any other center in New England. “The real message is that more people should be organ donors,” Formica says. “I’m one. I believe everyone should recycle themselves.”