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This year is shaping up to be record-breaking for living kidney donation at University of Utah Health's Transplant Center. The growth in the living donor program has come at a critical time because the number of patients who are waiting for a lifesaving or life-sustaining kidney transplant is rising sharply.
"The leading causes of kidney disease are diabetes and high blood pressure," said Miklos Molnar, MD, PhD, medical director of the kidney and pancreas transplantation programs and living donor transplantation program at University of Utah Health. "In addition, we are getting better at early diagnosis, so more patients are recognized to have kidney disease. This all leads to more patients diagnosed with advanced or end-stage kidney disease."
Molnar and his colleagues have seen the number of patients on U of U Health's kidney transplant waiting list increase by almost 60% over the past two years, from 263 in July 2022 to 415 in April 2024. At the same time, the number of living kidney donors in the transplant program is increasing.
"I think 2024 will be the year where you will see the numbers really go up," said Michael Zimmerman, MD, a transplant and hepatobiliary surgeon at U of U Health. "The numbers have drifted up from approximately 50 living donors to 60-plus. I think we are going to go into the 70s and maybe even 80s this year because of our involvement in the National Kidney Registry (NKR)."
Zimmerman credits Molnar with enhancing University of Utah Health's engagement in paired kidney donation or donor chains through the NKR and other kidney donation registries, such as the Alliance for Paired Kidney Donation (APKD). These registries work to link two or more organ-recipient pairs with organs that are most compatible to the recipient's biology.
"The point we are trying to make to all of our patients is that if you bring a donor into the program who can donate on your behalf, then you can either get a kidney from that person or another donor who might be a much better match," Molnar said.
Due to the large number of potential donors that a recipient can be matched with in a multi-center paired exchange program like the one operated through the NKR, it is almost always the best option for finding a close match. Molnar cited statistics showing that through the NKR's pair exchange program, U of U Health has access to about 1,000 donors every minute.
"This effort with NKR exposes our patients to the country versus only Utah or the region," Zimmerman said. "It allows them to have a higher chance at being matched, which is exciting. It also allows us to better match and thereby better serve younger populations that are, in my opinion, difficult to match." The strongest match is directly tied to a longer lasting kidney transplant.
"Everything is happening in the matching process," Molnar said. "If you have a perfect or very good match, it will be less burdensome over time in terms of rejection medications and less complications." A patient and donor are planning for decades after the transplant, so it's worth the time before surgery to find the best possible match.
Molnar also emphasized the critical importance of living donations in finding a timely kidney transplant for those on the waiting list. He pointed to numbers showing that kidney disease is one of the 10 leading causes of death in the United States, eclipsing the rate of deaths from breast and prostate cancer.
"[Kidney failure] is killing people faster than some of the cancers," Molnar said. "This is not a benign thing to be on the waiting list. The survival rate [without a transplant] after five years is about 40-50%." Patients who receive transplants have a survival rate of over 80% after five years.
U of U Health's effort to recruit kidney donors and support them and their transplant patients stretches across the Mountain West into states like Wyoming, Montana, and Idaho, which do not have transplant programs of their own. Under Molnar's guidance and leadership, U of U Health has expanded a transplant outreach clinic in Boise, Idaho, opened another in Helena, Montana and plans to open another clinic in Nevada this August.
"The good news is that we can offer donor evaluations at those clinics, which is unique for the University of Utah," Molnar said. "I don't think there are too many transplant centers that offer remote donor evaluations."
The clinics also support the transplant program's goal of identifying barriers to donation and removing them. "Distance is a barrier because it is costly and requires time," Molnar said. For transplant patients, the distances might also affect the long- and short-term outcomes of their surgery, according to Zimmerman.
"One of our research interests is looking at the distance from the primary transplant center and comparing it to surgical complications, surgical outcomes, and overall patient outcomes," Zimmerman said. "We are asking ourselves if those are affected or are we still able to do what we are supposed to do to maintain positive outcomes, despite the fact the patient might live far away."
Perhaps the biggest obstacles to living donation involve a lack of education along with the emotions surrounding the process. Zimmerman has firsthand knowledge of these challenges. "If you need a kidney, I will say 99% of the people in the world do not understand how difficult it is for you to ask for a kidney from someone else," he said.
This is why education is essential to a transplant program's success—for both the donor and the organ recipient. "We like to bring that education to the recipient and allow them to share it with their family and friends," Zimmerman said. "We also disconnect those processes so that donors can come forth on their own. We don't coerce people into doing something. We educate them and let them decide."
Living donation is critical when it comes to extending the lives of our older generations and ensuring a healthy and long life for children who also battle kidney disease. Molnar described the transplant center's focus on these important populations: "The living donor program, including the pair exchange program, can offer these young people a very good match, which should last for decades. And the goal is always a kidney for life."
As spring brings the promise of new growth and life, what better time to consider giving someone the gift of a life-saving kidney?
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