Old Kidneys and Young Kidneys

Recently I discussed the topic of organ trading. The ST article below raises an interesting point not previously mentioned in my old blog post nor by the readers who had commented.

ST July 17, 2008
Short queues for kidneys in Spain and Norway: Here's why
Kidneys from the elderly are accepted and more people are willing to be donors
By Salma Khalik

BEFORE considering organ trading, Singapore can increase its supply of kidneys by learning from Spain and Norway, says a top kidney specialist here.

The two European countries have short waiting lists for kidney transplants - unlike Singapore, where the average wait is nine years for the 560 people on the list.

Both countries accept kidneys from the elderly, whereas in Singapore, kidneys are taken only from people 60 years old and younger.

This immediately cuts off the supply of many kidneys every year. In Spain, a third of the cadaveric kidneys are from people over 60 years old.

Spain and Norway stand out in the world for their short list of patients waiting for kidney transplants. Their success has been cited in the current debate raging over whether Singapore should consider legalising the organ trade to meet the high demand here.

Organ trading is a criminal offence here and, in the last month, five men were charged in connection with the offence, the first such cases here.

The cases have resulted in some people calling on the Health Ministry to reconsider the ban on organ trading.

But before going down that route, Professor A. Vathsala, director of the kidney transplant programme at the National University Hospital, said Singapore should expand its organ donation programme first.

She has visited Norway and Spain and believes that some of their practices, such as removing the age restriction on cadaveric donation, could be adopted here.

Spain transplants both kidneys from an older donor - even someone in his or her 80s - into an elderly recipient.

'No organ goes 'wasted' to be buried needlessly when it can save the lives of so many others with organ failure,' she said.

The obvious question that comes to mind is whether older cadaveric kidneys and younger cadaveric kidneys yield equally good transplant results. (Strangely, the Straits Times article did not discuss this at all).

I did a quick Google search. The answer seems to be that younger cadaveric kidneys deliver better transplant results than older ones. How significant that difference is, I must leave to the experts to comment (a fair number of doctors regularly read my blog).

The next point to consider is whether the kidney patient would be better off with a transplanted old kidney, or with no kidney transplant at all. This could be a "beggars can't be choosers" situation. Your best bet might be with the old kidney, since a young kidney might never become available before you die.

Finally, back to the question of whether organ trading should be legalised. The way I see it, there are many ways to skin a cat, and they don't have to be mutually exclusive. For example, we could legalise organ trading and at the same time, accept the use of older cadaveric kidneys. At the same time, we could continue to encourage "altruistic" donations from living donors etc.

The goal is to save lives. We can simultaneously pursue different paths to that goal.