The nation's organ-transplant network is preparing a major change in how it rations scarce kidneys that would favor young patients over old in an effort to wring more life out of donated organs. Today, a donated kidney generally goes to the person who has been waiting longest in the region in which it becomes available, with exceptions made for certain medical factors. A kidney from a 25-year-old donor could be transplanted into a 75-year-old, who is likely to die years before the kidney would have stopped working. The new policy is being developed by the United Network for Organ Sharing, the nonprofit body that develops organ-distribution policy under a government contract. Surgeons and others leading the process expect the final proposal will rely significantly -- though not exclusively -- on the concept of "net benefit," which seeks to give kidneys first to those who will benefit most from them. "Waiting time is arbitrary," said Alan Leichtman, a University of Michigan kidney doctor helping to craft the policy. "It seems like a real shame that we're not being better stewards of the organs." The concept is gaining traction among transplant doctors but creating anxiety for some patients and surgeons who worry the new system will not be fair to all. "Is it correct or permissible for the system to say the five or six more years of life that a 60-year-old is going to get are less valuable, less important than the 15 more years of life the 30-year-old is going to get?" asked Richard Freeman, a transplant surgeon at Tufts-New England Medical Center in Boston. The UNOS board has yet to receive a specific proposal, and any decision by the board must be approved by the U.S. Department of Health and Human Services. Because of the concern over the "net-benefit" approach, waiting time is likely to remain a factor in the formula calculating who gets a kidney. Deceased donors provided 10,816 kidneys for transplant in 2005. Another 6,500 came from living donors, who usually give to a close friend or relative. But those organs fall far short of meeting demand, and the waiting list for a kidney has grown to more than 70,000 people. The reasons include the surge of diabetes, a principal cause of kidney failure, and the aging U.S. population. Some 4,000 people die waiting each year.
