Change in organ-matching criteria boosts kidney transplants in minorities

Thursday, February 5th 2004, 12:00 am
By: News On 6

Blacks, Hispanics and other minorities in desperate need of new kidneys are getting substantially more transplants since the U.S. criteria for matching up scarce donor organs and recipients were eased last year.

The nation's transplant network made the policy change last May, based on research that suggested the move could boost transplants in minorities as much as 6 percent without a significant increase in rejected organs.

``The preliminary observations suggest that, in fact, what we predicted is happening and that minorities are getting more organs,'' said Dr. Friedrich K. Port, president of the University Renal Research and Education Association in Ann Arbor, Mich.

Minorities are three times more likely than whites to have kidney failure and account for over half of the 56,500 Americans waiting for kidney transplants. But they are less likely than whites to find a good genetic match and spend more time on the waiting list.

In the first four months after the change in the genetic criteria, minorities accounted for about 39 percent of kidney recipients, an increase of about 7 percent from the same period the year before, Port said.

His group's study is published in Thursday's New England Journal of Medicine.

``The bigger problem is trying to get enough organs for everybody so we wouldn't have to make these very like King Solomon decisions,'' said Dr. John P. Roberts of the University of California at San Francisco, who was the study's lead author.

Dr. Clive O. Callender, founder of the National Minority Organ Tissue Transplant Education Program, said he had been campaigning for years for the change in what he called a discriminatory matching process.

``I'm thrilled that we're finally there and that the data now supports the fact that it was worth the fight,'' he said.

Waiting time and tissue matching are two of the factors used to decide who gets a kidney from a deceased donor. The donor organ and the patient are typically checked for matches of three pairs of genetic markers _ HLA-A, HLA-B and HLA-DR _ on the theory that the more matches, the better the outcome.

While minorities are just as likely as whites to donate their organs, they are at a disadvantage when the organs are doled out because they tend to carry less common combinations of the genetic markers.

So the researchers looked at whether the criteria could be safely eased to help minorities. They analyzed a four-year waiting list and subsequent transplants and followed them for three years. Their calculations showed that dropping the HLA-B match would have shifted 166 transplants in 2000 from whites to minorities, an increase of about 6 percent.

And that is approximately what happened in the four months after the policy change began last May.

The rate of transplant failure was projected to increase by only 2 percent. Port said longer follow-up is needed to see whether that is happening.

``There's very little cost of eliminating (HLA-B) in terms of graft failure,'' Port said. ``The price is very low and the advantage is very large.''

Port said top priority is still given to perfect matches of all six genetic markers.

Tissue matching is considered less a factor in kidney transplants from living donors and for other organ transplants. Kidneys from live donors now outnumber those from dead donors.

Transplant surgeon Dr. Cass Franklin of Des Moines, Iowa, said the policy change made by the United Network for Organ Sharing puts a welcome emphasis on waiting time. He said better medicines that prevent rejection have greatly improved outcomes and helped move the emphasis off matching.

``How do you tell a patient that's been waiting like eight years that you can't get the kidney (instead of) someone who's been waiting only two years because there's a slight genetic difference and supposedly your outcome is not going to be as good?'' asked Franklin, a member of the network's minority affairs committee.

Franklin said the transplant network is doing a study to see if beginning the waiting period at the start of dialysis _ instead of when accepted as a transplant candidate _ would increase transplants for minorities and the poor.

``Since this is a crisis _ there is an organ shortage _ then we have to make sure this is a fair and equitable system,'' Franklin said.