Exploring Innovative Approaches to Optimize Organ Placement and Reduce Discard Rates

Federal health authorities are actively investigating strategies to decrease the number of discarded organs and streamline the placement process for transplant candidates. During a recent meeting of the Organ Procurement and Transplantation Network (OPTN), attention was drawn to Hackensack University Medical Center, where Dr. Goldstein, a transplant surgeon, and his team are known for accepting kidneys that might be considered too risky by other transplant centers.

To empower patients, they begin the transplant process with an informative PowerPoint presentation that outlines the advantages of considering kidneys that may not be deemed perfect. Dr. Goldstein emphasizes patient involvement in the decision-making process, guiding them to weigh the risks associated with waiting for a more ideal kidney against the potential dangers of remaining on dialysis. He points out that being on a waiting list can be detrimental to a patient's health, as the likelihood of mortality increases the longer one is in kidney failure.

Dialysis is a temporary solution that filters waste products from the blood, but its long-term application poses increased risks for patients, including cardiovascular issues, infections, and a diminished quality of life. One patient, 73-year-old Clifford Toliver, shared his experience with dialysis after being diagnosed with renal disease in 2022. He vividly described the routine and isolation of the treatment, expressing his fear that it could define his existence and ultimately lead to his demise.

With guidance from Dr. Goldstein, Toliver opted to accept a kidney that others may have ignored, noting that it was 65 years old—a fact that made him reconsider his options. He expressed urgency in his situation, noting the slim chances of future matching opportunities if he denied the transplant.

Notably, Hackensack's transplant program has accepted kidney offers at a rate three times greater than the national average and maintains a patient survival rate of 97.5% one year post-surgery, as reported by the Scientific Registry for Transplant Recipients. Dr. Goldstein articulated the need to eliminate impediments while also encouraging transplant hospitals to increase their participation in the organ donation process.

He affirmed that collaboration among transplant hospitals and organ procurement organizations (OPOs) is essential to establishing solutions for the placement of challenging kidneys. This initiative could have profound implications for patients like Melanie Knoll, a diabetic whose kidney has failed, leaving her on dialysis for the past three years while waiting for a suitable donor. Knoll, who has no family members who can donate, is open to the idea of accepting a less-than-perfect kidney rather than continuing her reliance on dialysis, underscoring the critical nature of finding viable transplant options.