THOUSANDS of patients waiting for a kidney transplant will be offered new hope today by research that could vastly increase the number of donor organs available in Britain on the NHS.
More patients could receive kidneys from recently deceased donors after a study found that they perform just as well as those from brain-dead donors, who are not expected to recover.
The findings pave the way for reforms in transplant policy that could make an estimated 600 extra donor kidneys available to the NHS every year.
More than 7,000 people with kidney failure are waiting for a transplant in Britain, and about one in ten dies before a suitable donor organ can be found.
Of the 1,600 transplants carried out each year, researchers at the University of Cambridge say that just 32 per cent of kidneys are currently taken from people whose heart has stopped, known as non-heartbeating donors.
Kidneys from non-heartbeating donors are still thought by some patients and surgeons to be inferior to those taken from living brain-dead donors, owing to concerns that the kidneys may quickly break down without a blood supply. But provided the organs can be transplanted within 12 hours they are as safe and effective as those from someone whose heart is still beating, the researchers say today.
Writing in The Lancet medical journal, Professor Andrew Bradley and colleagues say that “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”.
Brain-dead donors are patients who have suffered massive, irreversible head injuries and require life support to stay alive. But improved treatment of patients with acute head injuries has reduced the supply of kidneys available from these donors. The shortage has led to an increase of kidneys from “controlled” cardiac deaths, where medical support is gradually removed from individuals with terminal injuries.
The researchers analysed data from 9,134 kidney transplants in 23 centres across the UK over the seven years to 2007. Of these, 8,289 kidneys were donated after brain death and 845 after cardiac death. They found no difference in survival rates or kidney function of recipients for up to five years after transplantation.
Doctors are required to wait for up to 25 minutes to declare a non-heartbeating donor legally dead. It had been thought that the loss of blood flow affected the long-term performance of kidneys but the new findings show that this is not the case. Organs from non-heartbeating donors take up to two weeks to fully assimilate with the recipient, who will require dialysis during this time.
The National Kidney Federation said that it hoped organs could now be sourced from willing donors who die in accident and emergency units as well as from donors in intensive care.
Dominic Summers, one of the authors of the paper from the School of Clinical Medicine, Cambridge, said the findings were “fantastic”, and would change the lives of many patients.
“We have found that although the patients with cardiac donor kidneys need to stay on dialysis for another two weeks, the kidneys work well in the future,” he said. “It is hard to find another patient so grateful as one that has received a new kidney – it completely transforms their life and makes it infinitely better.”
A national Kidney Advisory Group, chaired by Professor Bradley, is considering whether a national sharing scheme for kidneys from cardiac-death donors could be introduced in the UK.
Dr Summers added: “In view of our findings, we recommend that cardiac-death kidneys be allocated in a similar way as brain-death kidneys, ensuring better tissue matches and favouring those who have waited longest.”
A spokesman for the British Organ Donation Society said he was delighted that scientists had found a new potential pool of donors. He said: “This is great to hear. We fully approve of this development and hope it is the beginning of more donors becoming available.”
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