Rationing health care: with kidneys, rules will favor the young

Posted last week in the Wills Trusts and Estates Blog:

New rules for determining priority for organs may reduce the likelihood of older patients receiving kidneys.  See Alan Zarembo, With kidney transplants, a question of how to ration life, LA Times, Nov. 5, 2006, which explains:

Withlittle public scrutiny, transplant doctors and administrators arediscussing who should receive life-extending kidneys — and support isgrowing for a national system that would favor the young.

TheUnited Network for Organ Sharing, which oversees transplantation forthe federal government, has already given patients younger than 18 anadvantage. Last year, it moved them to the front of the line forhigh-quality organs from donors younger than 35. * * *

From a statistical standpoint, kidneys are being squandered.

Nearlyeverybody, at least up to age 70, lives longer with a transplant thanwith dialysis. But the young gain the most extra years of life. In themathematics of transplantation, they have the potential for the most”net lifetime survival benefit.”

Maximizing the benefit, in many respects, is a harsh calculation.

Race,weight, disease type and length of time on dialysis all count. Blacks,for example, tend to survive longer on dialysis than whites and Asians,but do less well with transplants. Obese patients tend to live longeron dialysis than normal-weight patients, but not as long withtransplants.

A purely utilitarian equation would favor young, trim whites and Asians who have been on dialysis less than a year.