IStockPhoto 4333727 © Landon England

As of mid-year, 2009, more than 80,000 people are in need of a kidney transplant in the US. Only 1 in 5 will receive one within 12 months. In 2008, 1 in 2.77 donated kidneys came from a living individual, while the rest were taken from deceased organ donors. With over 290 million potential donors in the US, many are calling for new pathways to be explored in order to reduce the number of people on the waiting list.

Each year the demand for kidneys grows faster than the supply can handle. As a result, thousands of patients waiting for a transplant must endure the difficult and expensive process of dialysis to filter their blood. Dialysis costs around $70,000 annually, which Medicare covers for many needing the treatment. The cost of dialysis is only part of the burden. Patients must have their treatment three times a week for three to five hours a session. Dialysis filters the excess wastes and salts from the blood – a task that the patient’s kidneys are no longer capable of doing. The time required and debilitating side effects render most patients unable to work. Once a person requires dialysis, they are dependent on it for the rest of their lives, unless they receive a kidney transplant.

One way to increase the number of kidneys available for transplant, but one which provokes heated debate, is to reverse the law that prohibits monetary compensation for the donation of an organ. Another option would be to change the deceased organ donation to an opt-out program from the existing opt-in system. Currently willing donors must enter themselves into the donor pool. In compliance with the Uniform Anatomical Gift Act, this can be done by filling out a donor card, or – depending on the state – making an indication on a driver’s license application. Still others make their wishes known through advanced medical directives, such as living wills.

Under an opt-out system no one would be required to donate their organs; however everyone would be on the donor list unless they actively removed themselves. Such opt-out systems are already in place in Spain, Belgium and Norway and have helped to improve rates of organ donations.

An uncontroversial method to raise the number of transplants already in use is paired donation. Here is the scenario: Patient A has a donor – say a relative or a friend – who is willing to donate a kidney but is not biologically compatible. Patient B – perhaps across the country – is in the same situation. If the donor for Patient A is compatible with Patient B, and the donor for Patient B is a good match for Patient A, a paired donation can occur and both patients will receive a kidney. In September 2009, the Kidney Paired Donation Pilot Program launched the first national paired donation system. This program has huge potential because it will allow matches from all over the country to locate each other and share the gift of life.

In 2008, 1 in 155.8 kidneys donated were from anonymous living donors and these acts of self-sacrifice have the potential to benefit more than one recipient. If a donor gifts his or her kidney to the paired donation system, it’s possible to create a chain of donations, allowing one altruistic donor to be a hero to many. A donor chain begins when the anonymous kidney is given to a patient on the waitlist with a willing but not matching donor. That donor then gives his or her kidney to another patient in a similar situation. So long as patients have a willing but not suitable donor, the chain can continue. Recently chains as long as eight and ten (PDF) kidneys have been successfully transplanted.