A kidney transplant operation on February 28, 2017 by surgeon Mario Alvarez Maestro at the La Paz Hospital in Madrid, Spain (AFP / PIERRE-PHILIPPE MARCOU)
When a patient waiting for a kidney transplant dies, his family will usually think that the shortage of organ donation is responsible. In the United States, the reality is more troubling: most of these deaths had actually received a kidney offer that was refused.
"We found that 84% of kidneys in the United States were refused at least once, which is crazy," Sumit Mohan, associate professor of medicine at Columbia University in New York, told AFP and senior author. of a study published Friday in a review of the American Academy of Medicine (Jama Network Open).
"It's absurd," insists the doctor.
A first study showed this week that American doctors rejected double the kidneys available for transplant, compared to French doctors (18% against 9%). US centers are extremely conservative about the age of deceased donors and throw away kidneys that are considered too old … yet they may be suitable for older or at risk patients.
The new analysis shows that a transplanted American patient received 17 offers previously rejected by his doctor (median number over the period 2008-2015). Those who die on the waiting list have received 16 offers. Ten patients on the waiting list die every day in the country when they have been offered a kidney.
"What is more problematic is that doctors say no to talk to patients," said Sumit Mohan.
When a person dies, his kidney is removed and offered to dialysis patients according to their place on the waiting list. In fact, the offer is sent to the patient's hospital, which has an hour to answer. Most of the time, the centers pass their turn hoping that another with a better quality score will arrive later.
For the authors, the focus on this score is a central problem, because patients would be quite willing to receive a kidney of less good quality, if only for not being on dialysis, an extremely painful treatment that requires go to the hospital several times a week.
The excessive caution of the centers is partly explained by their desire to maintain a high survival rate of one year for transplant patients, on which their certification depends on the authorities.
"It is obviously better to be grafted with a kidney of lower quality than to die," said Sumit Mohan.
For this doctor, a simple reform would dramatically increase acceptance rates: inform the patient when a kidney is refused on his behalf. "People want to stop dialysis, they do not care if the kidney graft is grade 1 or 2".
ico / iba