DOCTORS are planning to offer organs from “high-risk” donors such as cancer victims and drug addicts to seriously ill transplant patients because of a desperate shortage of healthy donors.
Organs considered too high risk because they come from a donor who has or had cancer, has an active infection, or has been a drug user, will be offered to patients who have less to lose because they are likely to die if they do not obtain a transplant soon.
The doctors are proposing to create a special “fast-track” waiting list for the high-risk organs .
Titus Augustine, director of transplantation at Central Manchester University Hospitals NHS Foundation Trust, who is leading the plans, said: “One of the things that we have been looking at is trying to match risk with risk. There are people on the list who are willing to take that risk, accept kidneys from people with known infection risk or cancer risk.”
There are now about 5,500 patients on the kidney transplant waiting list. Hundreds die every year waiting for a kidney while several hundred more are removed from the list because they have become too ill while waiting to undergo the transplant.
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The new proposal has been driven by a shortage of organs available for transplant.
Documents supporting it state: “The hypothesis underpinning this project is that the potential risks of [disease] and mortality associated with transplanting these kidneys could be less than the mortality in some selected patients, without transplantation.
“The aims of this project are to utilise and match these kidneys from donors who are currently being turned down with a group of urgent patients at risk of mortality without transplantation.”
The patients, who will typically have kidney failure and can no longer be treated by dialysis, will be given the option of going on the
high-risk waiting list where they may be offered an organ from a diseased donor. They will also remain on the general list.
The sick patients have the option of declining to go on the high-risk waiting list and remaining only on the standard one. However, they then face the prospect of dying before a lower-risk organ becomes available.
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The fast-track waiting list will take organs from donors who suffered from cancer where doctors believe the chances of the disease spreading to the recipient are low.
They will also take kidneys from donors known to have had viral infections, as well as from intravenous drug users and those who have had high-risk sex lives.
The proposal states: “The rationale for these organ turn downs is absolute risk avoidance.
“However, the potential transmission risk has not been accurately quantified and is, at best, an educated guess.
“Several potential donors with infections and [brain cancers] are young and have good working kidneys, which are not utilised due to the perceived risk of disease transmission.
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“The risk of transmission of the tumour in many of these malignancies is very low.”
The proposal is likely to raise concern from the public, however, following the death in Cardiff of two men who were given kidneys with a rare infection transmitted from an alcoholic donor.
The plan to use organs from high-risk donors, such as those who had cancer or infections, has the official backing of NHS Blood and Transplant, the National Health Service transplant authority.
Professor James Neuberger, associate medical director for organ donation and transplantation at NHS Blood and Transplant, said: “The sad truth is, not every patient waiting for a kidney transplant will get the organ they need.
“Last year, 279 patients across the UK in need of a kidney, pancreas or kidney and pancreas transplant died while they were on the waiting list.
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“An additional 585 patients were removed from the waiting list. This often happens when patients become too ill to receive a transplant and sadly many go on to die afterwards.
“This is an exciting proposal that suggests that, in addition to the national kidney allocation list, we will also identify patients who would be willing to take organs from higher-risk donors.
“NHS Blood and Transplant would offer these organs to kidney transplant centres according to an agreed and published protocol.”
The proposal is initially planned for Manchester, which has Britain’s largest kidney transplant programme and 10% of the national waiting list. It will then be opened up nationally.
Patients wait, on average, about three years on the kidney waiting list. Waiting times depend on when a kidney comes up that matches the patient’s blood group and tissue type.