April 08, 2020

Organ donation field leveled > New England policy seen as fairer way to distribute kidneys

PROVIDENCE, R.I. — New Englanders in need of kidney transplants are able to get them locally under a new system in which recipients get first dibs on organs donated at their nearest transplant hospital.

Previously, hospitals had given priority to patients who had been waiting the longest. Under that system, kidneys donated by the family of a deceased loved one in Rhode Island or New Hampshire often were sped to a patient in Boston.

Under the new kidney-sharing policy, the donor kidney is likely to stay at the hospital where it is donated, and all the patients in that hospital are given first consideration.

The system is the first of its kind in the country and is expected to be a model for other regions in the national network of organ donation, said Dr. Richard Rohrer, New England representative for the United Network for Organ Sharing, which oversees all transplants in the country.

The old system meant that younger transplant programs in Portland, Maine, and in Worcester and Springfield, Mass., weren’t getting many kidneys.

“People in smaller states were sending all the kidneys to Boston. In a sense they weren’t getting their fair share,” said Dr. Paul Morrissey, a transplant surgeon at Rhode Island Hospital, which began a transplant program in March.

“The waiting time for patients in Maine and the number of patients were growing, and that was a major concern of ours,” said Dr. Jonathan Himmelfarb, a kidney specialist at Maine Medical Center in Portland, which also does transplants.

The new system is expected to spread out a limited supply of kidneys, with about 350 kidneys donated each year and parceled out to 2,000 adults and children in New England.

Patients wait an average of three years for a kidney in New England.

Himmelfarb was one of many who helped to work out a system that assigns points to patients on New England’s waiting list each time a kidney becomes available. The new point system gives a patient’s location a higher value — up to 10 points — than waiting time — which is given up to 8 points.

The decision to change the system was made by transplant representatives in the New England Organ Bank, based in Boston, and the Northeast Organ Procurement Organization in Hartford, Conn., both of which make up Region I in the UNOS, the nonprofit group created by Congress to oversee transplants.

The new system began adding points for a patient’s location in September 1996, and when it failed to show the desired results, transplant directors revised it in December.

Not all agreed. Some transplant program directors believe kidneys should go to those who are waiting the longest, Rohrer said.

“In the end our region held a vote. It was 14 in favor to 2 opposed to 2 abstentions.”

Now, the system may make it more difficult to get a kidney in Boston, said Rohrer, transplant chief at New England Medical Center in Boston.

But he said transplant officials in Boston saw the fairness of the new system.

“Happily, some people can see you need a system that works for everybody. If you voted the fine points of just what’s best for you, you don’t get anywhere in society.”

By keeping transplants local, representatives hope the new system will lead to more donations, Rohrer said. The belief is that more people will donate if they hear more about transplants.

“When you open up a transplant program, consciousness about transplantation gets raised among hospital staff and people at large. People develop an understanding that transplants work. In a way, that doesn’t happen if it’s a distant phenomenon,” Rohrer said.

Doctors say it’s too soon to tell whether the new system will work, but in a small state like Rhode Island, a transplant surgeon was surprised to see the number of kidneys available.

“We were hoping to do 12 to 20 in our first year. We’ve done 35 so far,” Morrissey said.

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