By chance, I came across an old news story about a big historical change at the Univ. Washington Medical Center. The Seattle Times Mar 1992 reported that the UWMC transplant committee approved a policy to accept living kidney donors who were not genetically related to the recipient. The story points out that Swedish Hospital had allowed two such donations in the past, but doesn’t say if it had a policy or if the surgeries were performed ad hoc. Virginia Mason already had a policy in place to accept donations from spouses, but had never actually used such a donor. UWMC didn’t actually perform its first unrelated live donor transplant until more than two years later, in Oct 1994.

A bit more research uncovers an article (New York Times Jun 1993) that reports in the U.S., only 86 kidneys were transplanted from unrelated donors in 1991 and only 56 in 1988, the first year that statistics were kept. Today about half of live donors are unrelated to the recipient, providing a fifth of the kidneys transplanted in the U.S. or about 3,500 transplants a year (USRDS 2009).

The USRDS annual report also points out that as the proportion of patients with end-stage renal disease (ESRD) receiving transplants from unrelated donors has risen, the proportion receiving transplants from related donors has fallen. This indicates that previously, some patients would not have chosen a related donor initially, but ended up doing so because the hospital would not accept an unrelated donor.

This has implications for the process hospitals use to set ethical standards. One of the reasons hospitals initially refused to let unrelated people become donors is because they feared that such donors were more likely to have been coerced or paid. They ignored that the then current standard meant that related donors might be manipulated and that recipients could be forced to select a donor who although related, they has a less strong emotional attachment to than an unrelated person. This shows that hospitals should base ethical standards on whether a disinterested observer can see if patients are happy with their choices rather than assume a current standard is already ethically acceptable and any new standard has to prove it is better. For another discussion on coercion, see my Feb 2010 blog post.

[Update: For more on the rise of unrelated donor transplants, see Jun 2010 blog post.]

Advertisements