Dr. Jeffrey Veale is an assistant professor of urology in the David Geffen School of Medicine at UCLA and a transplant surgeon at Ronald Reagan UCLA Medical Center. Veale is also director of the UCLA Kidney Transplantation Exchange Program. This op-ed was published in the Wall Street Journal.
The numbers are staggering. Because of a lack of donor kidneys, an average of 13 people die every day while waiting for a transplant. There are more than 100,000 names on the kidney waiting list in the U.S. and another 30 million people with chronic kidney disease who are at risk of joining them. More than 85 percent of those on the waiting list in 2015 are still waiting.
The good news is that there were 17,878 kidney transplants in the U.S. last year, the most in a single year, according to the United Network for Organ Sharing. And the numbers may keep growing thanks to an innovative voucher program that started in 2014 at Ronald Reagan UCLA Medical Center and is spreading across the country.
Here’s how it works: If you donate a kidney now, you will receive a voucher that a loved one could use to secure a kidney in the future. The Advanced Donation program is coordinated through the National Kidney Registry, which uses a national database to quickly and efficiently match donors and recipients.
The idea was approved by the Ethics Committee of the American Society of Transplant Surgeons in June, and has been sent to that group’s executive committee for formal approval. Ten hospitals across the country have so far joined UCLA to honor the voucher program. Donors currently need to go to one of these hospitals to receive a voucher but many other centers are expected to join.
The voucher idea is the brainchild of retired judge Howard Broadman. His grandson Quinn was born with a single kidney that wasn’t fully functioning. The retiree knew that eventually the boy would need a lifesaving transplant. Yet Mr. Broadman, who was 60 years old when Quinn was born, knew that by the time the boy needed a kidney transplant, his grandfather would be too old to donate.
Mr. Broadman approached Ronald Reagan UCLA Medical Center and proposed a simple but brilliant idea. He offered to donate a kidney immediately to a stranger on the waiting list, if in return he could secure a kidney for his grandson when the time comes. Quinn would be prioritized for a kidney when he needed a transplant.
Nothing like this had ever been done, but the UCLA Living Donor Committee and the National Kidney Registry Medical Board agreed to do it. In December 2014, Mr. Broadman donated a kidney, and 4-year-old Quinn now has a voucher to redeem when he needs it, perhaps avoiding dialysis.
If only one-half of 1 percent of adults in the U.S. agreed to become living donors, we could rapidly clear the waiting list for kidneys. As dramatic as this sounds, it is important that potential donors be fully informed of the risks of donating a kidney. There is a 3 in 10,000 death rate and approximately a 5 in 1,000 chance that donors will develop end-stage renal disease.
Living-donor kidneys are ideal because they generally function twice as long as kidneys from deceased donors — indirectly reducing the wait list. Nearly 700,000 people are now on kidney dialysis in the U.S. Treating end-stage renal disease costs more than $30 billion each year — and takes an enormous physical and emotional toll on patients and their families. Imagine if doctors could address kidney disease long before that was even an issue.
With more kidneys to choose from, doctors could also more easily manage donor chains. Many people volunteer to donate a kidney to a friend or loved one in need, only to find out that they are not a compatible match. With this program, they could still donate, and the National Kidney Registry computer software would find a matching donor. One donor in the voucher program could be used to trigger a chain of transplants, creating the added benefit of freeing people from dialysis now, and their loved ones from dialysis in the future.
Potential donors often state that they are interested in donating a kidney but are hesitant because a spouse or a child could need one in the future. With the voucher program, that issue is no longer a concern.
As a transplant surgeon, I’m invigorated by the prospect of what this voucher program could mean. This could be our only realistic shot at eliminating the waiting list for kidney transplants.
