Unless a patient has a donor already lined up, a kidney transplant candidate must join the wait list for a cadaver organs. Qualifying for this wait list involves an extensive evaluation. According to the National Institute of Diabetes and Digestive and Kidney Diseases, more than 80,000 patients were on the waiting list for kidneys as of March 16, 2010, with still more patients seeking both a kidney and a pancreas. Since the supply of kidney is so limited, it is important that none of the available kidneys are wasted. Transplant qualifications assure that potential recipients are healthy enough to take advantage of the new kidney.
Organizations
Several organizations are instrumental in the development of qualifications and the distribution of organs. The United Network for Organ Sharing, known by the acronym UNOS, maintains a network of all transplant centers and organ procurement organizations. When a kidney becomes available, this system helps identify an appropriate recipient. UNOS is accessible 24 hours a day, every day of the week.
Qualifications
Individual hospitals perform evaluations to screen potential candidates for the waiting list. Although these evaluations differ slightly among hospitals, all of them look to the patient's physical and mental health. Many newly diagnosed patients are surprised to learn that they do not qualify unless they are close to renal failure. The rationale is that a transplanted kidney has a very finite life.
Physical Qualifications
The qualifications set forth by the transplant center at University of California-Davis are fairly representative. Since heart disease is the most frequent cause of death in kidney patients, transplant candidates must have acceptable cardiovascular function and an acceptable vascular system. A history of stroke might disqualify a candidate.
A history of existing infectious disease is also a barrier. Liver diseases such as hepatitis or active fungal or bacterial infection are also problematic. Transplant recipients take immunosuppressants--which could make the underlying infection profoundly worse.
It should be noted that these conditions do not necessarily prevent transplant if the patient has a donor.
Other Qualifications
Hospitals also consider the patient's weight, whether the patient is ambulatory and capable of performing activities of daily life without help. Since the patient will have to comply with a complicated drug regimen, doctors also look to past compliance and motivation. Mental illness and drug use can be a bar. Age is also a factor as some preference is given to children in need of kidneys,
Finances are a critical consideration. Inadequacy of health insurance and personal resources to pay for drugs is an obstacle to transplantation.
Controversy
There is an ongoing controversy regarding why very old patients are often unable unable to be transplanted. The rationale for barring such transplants is that kidneys must not be wasted. The Hoover Institution at Stanford argues that this problem would not be an issue if there were a better system of incentives for donors. In short, they argue that paying donors would increase the kidney supply. The counter-argument is that this approach has been tried with blood donations in the past. Financial incentives for blood donors were abandoned when the AIDS epidemic ruled out donations by intravenous drugs users and others who donated blood for money.
