Tool helps kidney transplant patients weigh their options

Scientists at Johns Hopkins have created a free, Web-based tool to help patients decide whether to accept an available donor kidney or wait for a healthier on in the future.

Historically, the researchers say, it has been difficult to quantify the risk of accepting a deceased-donor kidney that may have been infected by hepatitis C as compared to waiting months or years for a better organ. Many patients on the waiting list are at risk of dying—researchers estimate the risk of death at 5 to 15 percent every year—but often, organs that may have been at risk of infection are thrown away and never transplanted.

Before they are made available for transplant, kidneys and other organs from deceased donors are tested for infectious diseases such as HIV and hepatitis C. But even when the tests come back negative, there is still a risk of infection. Although the risk of transmission of hepatitis C is low for transplanted kidneys, more than 10 percent of deceased donors in 2011 met CDC criteria for infectious risk.

In a new study described online this month in the American Journal of Transplantation, the JHU researchers showed there are some patients for whom the survival benefit outweighs the risks of accepting a possibly infected organ. They developed a mathematical model, found online at www.transplantmodels.com/ird, to help predict which patients should opt for an immediately available organ.

"Because the supply of the healthiest donor organs is too small, patients need to consider all organ offers or risk dying while waiting for an organ," said study leader Dorry L. Segev, an associate professor of surgery at the Johns Hopkins University School of Medicine. "But this is a very hard decision, and many people turn down transplant offers that, in reality, would provide them significant benefit. Often they would have done much better taking the organ at hand than waiting for the next available one. This is the most important decision of a transplant candidate's life, and we have developed a novel tool we believe can help patients make the best choice."