If our Transplant Center staff determines that you are a transplant candidate, a living donor is often the best option.
If our Transplant Institute staff determines that you are a transplant candidate, a living donor is often the best option. If this is not an immediate possibility for you, then we add your medical profile to the national patient list for organ transplant that is maintained by the United Network for Organ Sharing (UNOS) in Richmond, Virginia. You will join a list of people waiting for a kidney donation from a deceased donor.
Our Transplant Institute tracks wait times each year by blood type. For these and other statistics, visit the Transplant Institute outcome and volume data section on our Web site. We measure transplant volume by organ type, waiting time for a transplant, one-year survival rate by organ type, and quality of life before and after the transplant.
The Scientific Registry of Transplant Recipients (SRTR) also publishes center-specific reports with a wide range of useful information about transplant programs operating in the United States. The information includes many features of the BIDMC transplant program, such as the number of transplants performed in recent years, waiting time and waitlist outcomes, and the post-transplant experience of our patients. The statistics allow comparisons to national averages, as well as to the experience for similar patients at other centers in the country. The waitlist report is based on BIDMC data for patients transplanted within the last five years.
The majority of deceased donor organs for BIDMC transplant patients come from donors in New England. The transplant is coordinated by the New England Organ Bank (NEOB), which operates according to policies set by the United Network for Organ Sharing (UNOS), as supervised by the federal government. When a donor is identified, the NEOB sends UNOS information about the donor, including blood type, vital statistics such as blood pressure and weight, donor age and cause of death, information about blood tests, blood test results and social history.
Standard and Extended Criteria Donors
Kidneys from deceased donors fall into two categories: standard criteria donor (SCD) kidneys and extended criteria donor (ECD) kidneys.
A standard criteria donor kidney comes from a deceased donor who is declared brain dead. Brain death is defined when someone is maintained on life support - including a respirator that breathes for him or her - and has a beating heart. This can happen after a severe traumatic brain injury, stroke or other injury to the brain. Brain death means that there is the irreversible loss of function of the brain. A diagnosis of brain death can be made on a careful neurological examination or by demonstrating loss of blood flow to the brain. A flatline EEG can also be used to confirm brain death (an EEG, or electroencephalogram, records and measures the brain's electrical activity). Once brain death has been declared, the donor is legally dead.
An extended criteria donor kidney comes from a deceased donor who has certain risk factors. The severe shortage of organs, and the growing wait for kidneys, has led to more widespread use of kidneys from donors not commonly used in the past. These extended criteria donors have the following risk factors:
- Age: the deceased donor is over age 60 (or age 50 with other risk factors)
- High blood pressure: the deceased donor has a history of high blood pressure
- Stroke: the donor died from stroke
- Some kidney damage: before the donor's kidney is removed, the serum creatinine level is higher than normal (greater than 1.5 mg/dL with normal usually being less than 1.0 mg/dL), indicating a level of kidney damage
We tell patients in advance that ECD kidneys may not be perfect. There is an increased risk of early and late loss of the kidney. However, the data shows that your survival is better with an ECD kidney than if you stay on dialysis. So for some patients, an ECD kidney is a good option.
If an ECD kidney becomes available and is a match for you, your physicians and surgeons will discuss with you specific aspects of the donor and kidney to help you make a decision about whether or not this is a kidney for you.
Still Other Extended Criteria Donors
Another type of non-standard donor kidney is from a non heart-beating donor, also known as Donation after Cardiac Death (DCD). These are donors with severe brain injury with no hope for meaningful recovery and who do not meet the criteria for brain death. The family in consultation with the patient's physician may decide to withdraw life support. After the patient's heart stops and he or she is declared dead, the patient is taken to the operating room and the organs are removed.
Again, because of the shortage of organs, and the growing numbers of patients waiting for transplantation, there are still other extended criteria donors. Your transplant team may propose you accept donor organs.
- With exposure to Hepatitis C and Hepatitis B, viruses that cause liver inflammation or
- From deceased individuals with high-risk lifestyles such as intravenous drug users and prostitutes
If one of these ECD kidneys is offered to you, your transplant team will discuss whether this is a good option for you. Kidney allocation and criteria for deceased donors is a complex process but we are here to offer advice and support, and to help you decide what is the best treatment choice for you.
