Ramesh K Batra
Yale University, USAl
Title: Age based living kidney donor selection: A bipartite ethical dilemma
Biography
Biography: Ramesh K Batra
Abstract
The first kidney transplant in 1954 set the precedent for success of living donor kidney transplants for End Stage Renal Disease (ESRD) patients across the world. Kidney transplant from a deceased or a living donor in general is the gold standard treatment for ESRD patients over dialysis. The survival benefit offered is significantly higher with a Living Donor Kidney Transplant (LDKT) in comparison to a Deceased Donor Kidney Transplant (DDKT). Amongst the LDKT, much similar to the results for a DDKT, it is observed that a younger donor kidney leads to a longer graft and patient survival. Therefore, when a recipient with multiple donor options is evaluated by a transplant center, whilst controlling for other factors, a younger age becomes a preferred choice whilst selecting the appropriate donor. Therefore, it appears that selection of a living kidney donor is more likely based on the recipient outcome. But, from a purely living kidney donor perspective, the impact of nephrectomy on life expectancy and cumulative risk of ESRD worsens with advancing age of the donor. This impact is more pronounced for black males as compared to white. So, a younger black donor suffers higher long-term risks after kidney donation, although they provide a superior quality allograft for the recipient. Similarly, following a utilitarian approach, Estimated Post Transplant Survival score (EPTS) should also be applied to living donor kidney recipients when encountered with multiple donor options. A living donor transplant is geared with the primary responsibility towards minimizing risks to the donor and this consideration should be followed when choosing between a donor, rather than the objectivity of age. This consideration should also include the recipient age and their life expectancy to achieve maximum utility of the donated allograft, by utilizing the EPTS score.