Why we need more altruistic kidney donors
The UK statistics are shocking:
- 300 people in need of a kidney die each year
- around 6000 people are on the waiting list for a kidney transplant
- Only 2500 kidney transplantations take place each year
So, 3,500 people who could benefit from a transplant each year are not getting one.
If Britain had more kidneys available for transplantation, the waiting list for transplants would shrink. In human terms, many more people could come off dialysis and regain their health and independence.
The history of kidney transplantation in the UK goes back more than 50 years. The first kidney transplantation was performed in 1960. Since then, more than 60,000 patients have received kidney transplants. The success rate for these transplants is very high: one year after surgery about nine out of 10 transplanted kidneys are working well.
Kidneys for transplantation can come from living donors or deceased donors. The success rate for transplants from living donors is slightly better than that for transplants from deceased donors: 90-95% are working well one year after transplantation, compared with 85-90% for those received from a cadaver (NHSBT statistics: www.organdonation.nhs.uk/ukt/how_to_become_a_donor/living_kidney_donation/questions_and_answers.jsp).
Despite public campaigns over many years to increase the number of donations from deceased donors, there is still a severe shortage of kidneys. This is one reason why the waiting list for kidney transplants remains so big. Although many people generously sign up to the Organ Donor Register to allow their organs to be donated should they die, there will never be enough deceased donors to meet the demand for transplants.
Living donors are the second group of people who can donate kidneys for transplantation. Until recently, living donors were mostly close relatives who volunteered to donate a kidney to a loved one who was suffering from kidney failure. Friends and relatives are an important source of kidneys for transplantation, but experience has shown that they will never provide enough kidneys to bring the waiting list down.
If friends and relatives and deceased donors are not able to provide enough kidneys, who else can help?
Until 2006, all living donors were either relatives or friends of people who received a kidney transplant.
In 2004, guidance under the new Human Tissue Act stated that altruistic kidney donation was permitted. Altruistic donation, sometimes also known as non-directed altruistic donation, is the term that describes a donation that is given without knowledge of who is going to receive the kidney. An altruistic donor simply volunteers to give away a kidney to someone who needs it. NHS Blood and Transplant finds a suitable recipient, and the transplantation is arranged by the local kidney transplant centres of the donor and recipient.
The new framework created the opportunity for many more people to donate a kidney. For the first time, it was now possible to donate a kidney to a stranger. Although at first this may seem an odd idea, it is the same system that we use for blood donations. Blood donors simple decide to give a pint of blood – they don’t know who is going to receive their blood. They donate their blood altruistically, because they want to help someone else who needs a blood transfusion.
The number of altruistic kidney donors is still relatively small, but it is increasing every year.
In 2007-8, when the first altruistic donations started to happen, there were six such transplantations. A year later (2008-9) there were 15. The number then rose to 16, and in 2011-12 it was up to 34. In 2012-13 the total was 76, and in 2013-14 the number will be even greater.
Give a kidney wants to see the number of altruistic kidney donations continue to increase. Every successful altruistic kidney donation allows a patient to come off dialysis. Patients who receive kidney transplants feel healthier. They still need to have regular care and monitoring from kidney specialists, but it is no exaggeration to say that a kidney transplant gives a new lease of life.
In future, altruistic donors will be able donate a kidney to something called the paired/pooled donation scheme.
The paired/pool scheme involves four or more people, made up of two or more “couples.” One person in each couple is waiting for a kidney transplant, and the other wants to give a kidney but is not a good enough match to give one to the other one. He or she therefore volunteers to give a kidney to a member of a similar couple, in return for a kidney for his or her partner. The “couples” could be married partners, unmarried partners, two relatives or two friends.
The “paired” scheme involves two “couples”, and the “pooled” scheme involves more than two.
If an altruistic donor offers to donate his or her kidney to such a scheme, it can result in an altruistic donor chain with two or more people receiving a kidney.
The donation of a kidney also saves the NHS a great deal of money. Keeping someone on a dialysis machine costs about £29,000 a year, or £290,000 over 10 years. The cost of a kidney transplant over 10 years, by contrast, comes to only £102,000, which includes the cost of the operation, the cost of follow-up appointments and the cost of drugs that the patient has to take to stop the body rejecting the organ. So the saving over a 10 year period is almost £200,000. (Source: Specialised Commission Team West Midlands, 2010)
So if the UK could increase the number of kidney transplants by just 100 a year that would save the NHS £20 million over the next 10 years. And if the increase of 100 transplants could be sustained for the following year, that would save another £20 million over the following 10 years.
So the need for more donors is compelling.