Kidneys ready for donation are a precious resource. There are far more people who need them than there are donors, including both living and deceased donation.
“The bottom line is we don’t have enough organs to give them to everybody who needs one,” says Michael Angelis, MD, AdventHealth’s surgical director of kidney transplant. When someone doesn’t have a living donor, they can get on the list to receive a kidney from someone who has died.
This raises an important question: When a life-changing kidney becomes available, who gets it? Contrary to what some patients assume, kidneys don’t simply go to who is the sickest.
The details about who gets priority for kidney transplant have important lessons for people who’re waiting for a kidney. The overall goal is for each kidney to be given to the person it’s the best match for — the person it is most likely to save.
(If you’re looking for more basic information on the kidney transplant process, check out our blog post.)
Who Has Priority?
A nonprofit called the United Network for Organ Sharing, or UNOS, manages the national transplant waiting list. It matches donors to recipients, meaning it decides who gets which organs.
Dr. Angelis says there are three groups of people who may have priority to receive an organ transplant:
● Children. Kidney failure can harm a child’s development, so they get priority for a transplant.
● Highly sensitized patients. These people are hard to find a kidney for because their bodies reject most people’s kidneys. When a match is found, they get higher priority.
● High-quality matches. When a potential kidney recipient is an excellent match for an available kidney — meaning it is more likely to work in their body — they get higher priority.
Some people assume that transplanted organs are given first to people who are closest to dying. But Dr. Angelis says organs go to the person who is expected to live the longest with them. Someone who is very ill may not be a good candidate for transplant because they might not survive the operation or may not live long even with the kidney.
These are hard choices, he says.
“We want to give each organ to the right patient, the one most likely to get the biggest benefit from it,” Dr. Angelis says. “I’m sure donor families want it to go to people who would get the best use of it.”
However, the most important factor deciding who gets a kidney is simple: Time.
Making Your Wait Time Count
The clock starts ticking not when you join the waitlist, but when you begin dialysis, a procedure to filter the blood using machines.
Typical wait times vary by region; in Florida, a four-year wait is typical, Dr. Angelis says.
A key goal of a person who wants a kidney transplant is to get on the waitlist and stay there. About half of the people on the waiting list are on hold, he says, either because they are too sick to undergo surgery or haven’t been evaluated fully.
That means staying healthy and on top of your tests is an important way to be ready when a kidney becomes available.
Local recipients get priority because kidneys start to break down when they’re outside of a body. Even when steps are taken to preserve a kidney, it can’t be kept viable for much longer than 24 hours.
Because each donated kidney is a potential life-changing opportunity to patients, Dr. Angelis vaults into action when he learns one may be available.
A Kidney Matchmaker
When he hears that an organ is available from a deceased donor, Dr. Angelis will usually do the operation to remove it himself. Determining who might be the best match includes what’s called a “cross-match.”
This is a blood test in which cells from the donor are mixed with cells from a potential recipient. The goal is to see if the recipient’s immune system will recognize the donor as a foreign invader and attack it. If this happens, the donation can’t take place.
Dr. Angelis says he typically conducts these tests on about a half-dozen of his patients to look for a good match locally. The whole process — from when the kidney is removed from a deceased donor to when it’s transplanted into a recipient — typically lasts from 12 to 24 hours, he says.
Consider Being an Organ Donor
The best way for most people to help those who are waiting for an organ is to agree to donate their organs when they die.
“If we had enough deceased donors, then this issue of people not getting kidneys wouldn’t exist,” Dr. Angelis says.
He recommends identifying as an organ donor on your driver’s license. This means your family won’t have any doubt about your intentions.
The AdventHealth Transplant Institute’s dedication to our patients’ best interests helps us offer wait times that are shorter than national averages. Meanwhile, we support patients who are waiting for a kidney in body, mind and spirit, which helps us rank in the top 1 percent nationally in patient satisfaction.
We invite you to learn more about how we guide patients through their organ transplant journey.