Kidney transplants could be more plentiful — and safe — if U.S. eased age limits, study finds

Peter Reese couldn’t believe what he just heard.

The associate professor of medicine and epidemiology at the Perelman School of Medicine at the University of Pennsylvania was in France for a yearlong sabbatical when someone mentioned an 83-year-old kidney donor.

“I really wondered whether or not I misheard them," he said, adding he was still getting used to speaking French. A donor that old would be extraordinary, especially in the United States, where the average age of a kidney donor is 39.

He got it right.

In France, where the average age of a donor is about 56, kidneys are not automatically rejected from older donors or from those who had health issues like high blood pressure or diabetes, factors that would exclude them from U.S. donation. French organ centers are far more likely to use “lower-rated kidneys” for transplant, Reese found.

Used for older transplant recipients, French success rates show that kidneys from donors in their 50s and 60s represent an untapped opportunity to extend life, Reese found in a study published Monday in JAMA Internal Medicine.

If the U.S. adopted the model used in France, it could provide a total of more than 10,000 years of life with a functioning kidney to transplant patients each year, he found in the start of his study to compare deceased kidney donors in the U.S. and France.

About 37 million U.S. adults have chronic kidney disease; more than 720,000 people have kidney failure and require a transplant or dialysis to survive. Kidney disease is the ninth leading cause of death in the U.S.

There are about 90,000 Americans currently awaiting a kidney and about 5,000 Americans die each year while waiting for a transplant, the study found. (That problem is global; about 3,000 Europeans die each year while waiting for kidneys.)

Yet, every year about 3,500 donated kidneys in the U.S. are discarded, the study found.

From 2004 to 2014, the U.S. discarded about 18% of the “lower rated” kidneys, about twice the discard rate in France.

“We certainly have a major shortage of organs,” said Reese. “But surprisingly, we still discard a lot of kidneys that are donated — about 20% a year.”

About one-third of the people needing a transplant are over age 60, a proportion that has steadily risen. Yet U.S. practice is not to use kidneys from deceased donors in the same age bracket.

The study did not look at practices regarding live donors, Reese said.

Reese says kidney transplant centers, facing regulatory scrutiny from federal agencies, would rather avoid the potential risk of using an older kidney.

“Centers are so afraid of a bad report card," said Reese. “They really want to wait for the best kidney.”

France has a less-strictly regulated system and is more willing to push the envelope when it comes to older donors, he said.

“This study demonstrates that there is more the U.S. can do to prevent the deaths of thousands of Americans each year who are waiting for a transplant," said coauthor Alexandre Loupy, nephrologist at the department of nephrology and kidney transplantation at Necker Hospital in Paris and head of the Paris Transplant Group.

“Our findings reinforce how collaboration between countries can lead to a concrete new direction on how to help address a global health problem and advance care for wait-listed kidney patients in the United States,” Loupy said in a press release.

One surprise for Reese was that over the 10-year study period, the average age of a donor in the U.S. did not really change. But in France, it crept up as they began to use the older donor kidneys, he said.

Reese isn’t sure the study will change much in the short run, but feels the paper is coming out at an opportune time.

“It takes us closer to settling the debate which we’ve been having," he said. "Are we throwing away good kidneys or are we throwing away bad ones?”